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NPI Code Detail

MEDICARE: WILLIAM BRUCE POVOLNY M.D.

MEDICARE:   WILLIAM BRUCE POVOLNY  M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine Physician4887NV
2207Q00000XFamily Medicine Physician4887NV

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1588718340
Entity Type Code : Individual
Provider Name (Legal Business Name) : WILLIAM BRUCE POVOLNY M.D.
Provider Business Mailing Address
First Line : 680 S ROCK BLVD
Second Line :
City : RENO
State : NV
Zip : 89502-4113
Country : US
Telephone Number : 775-329-6300
Fax Number : 775-336-0653
Provider Business Practice Location Address
First Line : 330 CRAMPTON ST
Second Line :
City : RENO
State : NV
Zip : 89502-2480
Country : US
Telephone Number : 775-336-3700
Fax Number : 775-336-3701
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/22/2007
Last Update Date : 05/23/2022

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Directions to “ WILLIAM BRUCE POVOLNY M.D.” Practice Location

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