MEDICARE: DR. KEITH ALLEN BREILAND M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	6249	NV
2	2084P0800X	Psychiatry Physician	6249	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1124193206
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEITH ALLEN BREILAND M.D.

Provider Business Mailing Address
First Line	:	8936 SPANISH RIDGE AVE STE 106
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-1354
Country	:	US
Telephone Number	:	702-731-0909
Fax Number	:	702-826-4757

Provider Business Practice Location Address
First Line	:	400 SHADOW LN STE 106
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89106-4355
Country	:	US
Telephone Number	:	702-731-0909
Fax Number	:	702-826-4757

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/22/2006
Last Update Date	:	10/29/2019

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Directions to “ DR. KEITH ALLEN BREILAND M.D.” Practice Location

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