MEDICARE: JOHN R BRIAN PA-C

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	363AM0700X	Medical Physician Assistant	PA692	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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457334294
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN R BRIAN PA-C

Provider Business Mailing Address
First Line	:	PO BOX 98813
Second Line	:	SUITE 201
City	:	LAS VEGAS
State	:	NV
Zip	:	89193-8813
Country	:	US
Telephone Number	:	702-982-3659
Fax Number	:	702-549-0377

Provider Business Practice Location Address
First Line	:	5495 S RAINBOW BLVD
Second Line	:	SUITE 201
City	:	LAS VEGAS
State	:	NV
Zip	:	89118-1871
Country	:	US
Telephone Number	:	702-982-3659
Fax Number	:	702-549-0377

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

Provider Enumeration Date	:	11/25/2005
Last Update Date	:	10/27/2016

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