Healthcare Provider Details

I. General information

NPI: 1386842938
Provider Name (Legal Business Name): JOHN PATRICK BROSIOUS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JOHN PATRICK BROSIOUS M.D.

II. Dates (important events)

Enumeration Date: 07/05/2007
Last Update Date: 10/26/2023
Certification Date: 10/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

341 N BUFFALO DR STE B
LAS VEGAS NV
89145-0376
US

IV. Provider business mailing address

341 N BUFFALO DR STE B
LAS VEGAS NV
89145-0376
US

V. Phone/Fax

Practice location:
  • Phone: 702-727-8500
  • Fax: 702-444-2461
Mailing address:
  • Phone: 702-727-8500
  • Fax: 702-444-2461

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberMD447430
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number16256
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: