Healthcare Provider Details

I. General information

NPI: 1871120329
Provider Name (Legal Business Name): BRYAN JAMES ADAM DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2020
Last Update Date: 07/25/2023
Certification Date: 07/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10105 BANBURRY CROSS DR STE 170
LAS VEGAS NV
89144-6647
US

IV. Provider business mailing address

10105 BANBURRY CROSS DR STE 170
LAS VEGAS NV
89144-6647
US

V. Phone/Fax

Practice location:
  • Phone: 702-765-5437
  • Fax: 702-240-7268
Mailing address:
  • Phone: 702-765-5437
  • Fax: 702-240-7268

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberDO3408
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: