|Provider Name||JONATHAN PATRICK STAIDLE M.D.|
|Provider Location Address||4814 SPARKS BLVD SPARKS, NV 89436|
|Provider Mailing Address||640 W MOANA LN RENO, NV 89509|
|NPI Entity Type||Individual|
|Medical School Name||NORTHEASTERN OHIO UNIVERSITY COLLEGE OF MEDICINE|
|Is Sole Proprietor?||No|
|Is Organization Subpart?||N/A|
|Last Update Date||01-19-2021|
JONATHAN PATRICK STAIDLE M.D.
4814 SPARKS BLVD
Phone: (775) 327-0699
Fax: (775) 451-7501
JONATHAN PATRICK STAIDLE M.D.
640 W MOANA LN
Phone: (775) 324-0699
The secondary taxonomy codes define the provider type, classification, and specialization. For individual NPIs the license data is associated to each taxonomy code.
|No.||Taxonomy Code||Type||Classification||Specialization||License No.||State||Primary|
|1||207ND0101X||Allopathic & Osteopathic Physicians||Dermatology||MOHS-Micrographic Surgery||MD457066||PA||No|
Taxonomy Description: the highly-trained surgeons that perform Mohs Micrographic Surgery are specialists both in dermatology and pathology. With their extensive knowledge of the skin and unique pathological skills, they are able to remove only diseased tissue, preserving healthy tissue and minimizing the cosmetic impact of the surgery. Mohs surgeons who belong to the American College of Mohs Surgery (ACMS) have completed a minimum of one year of fellowship training at one of the ACMS-approved training centers in the U.S.
Additional identifier(s) currently or formerly used as an identifier for the provider. The codes may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.
|Identifier||Type / Code||Identifier State|
Other Providers at the same location
The following 2 providers are registered at the same or nearby location.
What is the National Provider Indentifier (NPI)?
The NPI is 10-position all-numeric identification number assigned by the NPPES to uniquely identify a health care provider.
Provider Location Address
The location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Mailing Address
The mailing address of the provider being identified. This address may contain the same information as the provider location address.
Entity Type Code
The code describing the type of health care provider that is being assigned an NPI.
The entity type codes are:
1 = Person: individual human being who furnishes health care;
2 = Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Subparts are the components and separate physical locations of organization health care providers. Subpart examples include:
Hospital components include outpatient departments, surgical centers, psychiatric units, and laboratories. These components are often separately licensed or certified by States and may exist at physical locations other than that of the hospital of which they are a component.
Provider Other Organization Name
The other organization name is the alternative last name by which the provider is or has been known (if an individual) or other name by which the organization provider is or has been known. The code identifying the type of other name. The provider other organization name codes are:
1 = former name;
2 = professional name;
3 = doing business as (d/b/ a) name;
4 = former legal business name; :
5 = other.
Provider Enumeration Date
The date the provider was assigned a unique identifier (assigned an NPI).
Last Update Date
The date that a NPI record was last updated or changed.
Primary Taxonomy Code
The primary taxonomy code defines the provider type, classification, and specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
Authorized Official Name
The name of the person authorized to submit the NPI application or to officially change data for a health care provider.