Healthcare Provider Details

I. General information

NPI: 1861769713
Provider Name (Legal Business Name): BROGAN, DOPF, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2011
Last Update Date: 09/14/2022
Certification Date: 09/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 W LIBERTY ST
RENO NV
89501-2011
US

IV. Provider business mailing address

325 W LIBERTY ST
RENO NV
89501-2011
US

V. Phone/Fax

Practice location:
  • Phone: 801-692-7159
  • Fax:
Mailing address:
  • Phone: 801-692-7159
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: MJ JENKINS
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 801-692-7159