Healthcare Provider Details

I. General information

NPI: 1689841421
Provider Name (Legal Business Name): BRYSON GIBBS RICHARDS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2008
Last Update Date: 11/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6020 S. RAINBOW BLVD BLDG C
LAS VEGAS NV
89118
US

IV. Provider business mailing address

6020 S. RAINBOW BLVD BLDG C
LAS VEGAS NV
89118
US

V. Phone/Fax

Practice location:
  • Phone: 702-870-7070
  • Fax: 702-870-0068
Mailing address:
  • Phone: 702-870-7070
  • Fax: 702-870-0068

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number15319
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: