Healthcare Provider Details

I. General information

NPI: 1861583429
Provider Name (Legal Business Name): BUD A WEST MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 RYLAND ST
RENO NV
89502-1605
US

IV. Provider business mailing address

900 RYLAND ST
RENO NV
89502-1605
US

V. Phone/Fax

Practice location:
  • Phone: 775-323-2157
  • Fax: 775-323-0749
Mailing address:
  • Phone: 775-323-2157
  • Fax: 775-323-0749

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number2980
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: