Provider Demographics
NPI:1871572768
Name:NUGENT, JEFFREY S (MD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:S
Last Name:NUGENT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8610 TECHNOLOGY WAY
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89521-5941
Mailing Address - Country:US
Mailing Address - Phone:775-826-4900
Mailing Address - Fax:775-826-3257
Practice Address - Street 1:8610 TECHNOLOGY WAY
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89521-5941
Practice Address - Country:US
Practice Address - Phone:775-826-4900
Practice Address - Fax:775-826-3257
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV12085207K00000X, 207RA0201X
FLME 91393207RA0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLVAD000Medicare UPIN