Provider Demographics
NPI:1477664423
Name:NARAG FALLON FAMILY CLINIC, P.C.
Entity Type:Organization
Organization Name:NARAG FALLON FAMILY CLINIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:REYNALDO
Authorized Official - Middle Name:B
Authorized Official - Last Name:NARAG
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:775-428-2747
Mailing Address - Street 1:PO BOX 615
Mailing Address - Street 2:
Mailing Address - City:FALLON
Mailing Address - State:NV
Mailing Address - Zip Code:89407-0615
Mailing Address - Country:US
Mailing Address - Phone:775-428-2747
Mailing Address - Fax:775-428-2179
Practice Address - Street 1:1077 NEW RIVER PKWY
Practice Address - Street 2:
Practice Address - City:FALLON
Practice Address - State:NV
Practice Address - Zip Code:89406-6894
Practice Address - Country:US
Practice Address - Phone:775-428-2747
Practice Address - Fax:775-428-2179
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV8884207R00000X
NV8787208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV101644Medicare ID - Type Unspecified