Healthcare Provider Details

I. General information

NPI: 1124814447
Provider Name (Legal Business Name): BIRCH MEDICAL AND SKIN CARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2025
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4095 N CARSON ST
CARSON CITY NV
89706-1936
US

IV. Provider business mailing address

4095 N CARSON ST
CARSON CITY NV
89706-1936
US

V. Phone/Fax

Practice location:
  • Phone: 775-883-3953
  • Fax:
Mailing address:
  • Phone: 775-443-1530
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DANIEL JOHN BRADFORD
Title or Position: OWNER
Credential:
Phone: 808-443-1010