Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081P2900X | Pain Medicine | 9574 | NV |
NPI | 1073613766 |
---|---|
Provider Name | Dr. Stephen Brown |
First Address | Reno, NV 89510-7458 |
Second Address | Reno, NV 89509-6903 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/09/2006 |
Last Update Date | 01/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100502188 | (05) | NV |
9574 | LICENSE (01) | NV |
G35409 | (02) |