Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 10620 | NV |
N | 207RA0401X | Internist - Addiction Medicine | 10620 | NV |
NPI | 1538225776 |
---|---|
Provider Name | Bret Michael Bellard |
First Address | Reno, NV 89502-1576 |
Second Address | Carson City, NV 89701-4528 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/12/2006 |
Last Update Date | 02/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
11997161 | CAQH (01) | |
1538225776 | (05) | NV |
H07951 | (02) |