Provider Demographics
NPI:1780657114
Name:DUNCKELMEYER, JORG FRIEDRICH (MD)
Entity type:Individual
Prefix:
First Name:JORG
Middle Name:FRIEDRICH
Last Name:DUNCKELMEYER
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 1:1155 MILL ST # M14
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-1576
Mailing Address - Country:US
Mailing Address - Phone:775-982-5262
Mailing Address - Fax:775-982-6271
Practice Address - Street 1:1155 MILL ST
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-1576
Practice Address - Country:US
Practice Address - Phone:775-982-4090
Practice Address - Fax:775-982-6271
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA53405207L00000X
NV9754207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV2018562Medicaid
NV11050726OtherCAQH #
NV2018562Medicaid
NVV34738Medicare PIN
NV34738Medicare ID - Type Unspecified
CAXPY202892OtherCALIFORNIA MEDICAID
NVV34738Medicare PIN
NV34738Medicare ID - Type Unspecified