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NPI Code Detail

MEDICARE: BRANDON J STILSON M.D.

MEDICARE:   BRANDON J STILSON  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
1207Q00000XFamily Medicine PhysicianDR.0057179CO
2390200000XStudent in an Organized Health Care Education/Training Program
3207Q00000XFamily Medicine Physician1508201880NV

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
120972OTHERNVSTATE LICENSE
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1508201880
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRANDON J STILSON M.D.
Provider Business Mailing Address
First Line : 6355 S BUFFALO DR FL 3
Second Line :
City : LAS VEGAS
State : NV
Zip : 89113-2133
Country : US
Telephone Number : 702-216-3346
Fax Number : 702-671-6883
Provider Business Practice Location Address
First Line : 786 W PIONEER BLVD STE A
Second Line :
City : MESQUITE
State : NV
Zip : 89027-8862
Country : US
Telephone Number : 702-345-5000
Fax Number : 702-345-2000
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/01/2013
Last Update Date : 10/20/2022

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Directions to “ BRANDON J STILSON M.D.” Practice Location

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