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NPI Code Detail

MEDICARE: DR. PHYLLIS JOYCE AGER MD

MEDICARE: DR. PHYLLIS JOYCE AGER MD
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
12085R0001XRadiation Oncology PhysicianMD61616345WA
22085R0203XTherapeutic Radiology PhysicianG21590CA
32085R0001XRadiation Oncology Physician11890NV

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
111201067OTHERCAQH

General Provider Information

NPI Number : 1962405456
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. PHYLLIS JOYCE AGER MD
Provider Business Mailing Address
First Line : 780 KUENZLI ST
Second Line : STE 202
City : RENO
State : NV
Zip : 89502-0837
Country : US
Telephone Number : 775-982-5205
Fax Number : 775-982-5496
Provider Business Practice Location Address
First Line : 1155 MILL ST
Second Line : MAIL CODE L11
City : RENO
State : NV
Zip : 89502-1576
Country : US
Telephone Number : 775-982-4000
Fax Number : 775-982-5639
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/27/2005
Last Update Date : 03/06/2025

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