Provider Demographics
NPI:1548440183
Name:WILLIAM T. MIYAZAKI, D.O., PC
Entity type:Organization
Organization Name:WILLIAM T. MIYAZAKI, D.O., PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:T,
Authorized Official - Last Name:MIYAZAKI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:775-972-9100
Mailing Address - Street 1:5990 SILVER LAKE RD
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89506-2301
Mailing Address - Country:US
Mailing Address - Phone:775-972-9100
Mailing Address - Fax:775-972-9101
Practice Address - Street 1:5990 SILVER LAKE RD
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89506-2301
Practice Address - Country:US
Practice Address - Phone:775-972-9100
Practice Address - Fax:775-972-9101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-12
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV447207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVD42967Medicare UPIN
NVVWCHKCMedicare PIN