MEDICARE: MR. BRIAN KEITH SHRAWDER PHYSICIAN ASSISTANT

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	PA1157	NV
2	363A00000X	Physician Assistant	PA1157	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	:	1962720896
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BRIAN KEITH SHRAWDER PHYSICIAN ASSISTANT

Provider Business Mailing Address
First Line	:	4616 W SAHARA AVE
Second Line	:	#337
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-3654
Country	:	US
Telephone Number	:	702-227-4040
Fax Number	:

Provider Business Practice Location Address
First Line	:	1900 N NELLIS BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89115-6743
Country	:	US
Telephone Number	:	702-880-4193
Fax Number	:	702-531-6440

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

Provider Enumeration Date	:	05/17/2010
Last Update Date	:	05/31/2024

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