Basic Information
| Provider Information | |||||||||
| NPI: | 1669669990 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BRYAN L. RICKS, M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 21530 | ||||||||
| Address2: | |||||||||
| City: | CARSON CITY | ||||||||
| State: | NV | ||||||||
| PostalCode: | 897211530 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7758842455 | ||||||||
| FaxNumber: | 7758840345 | ||||||||
| Practice Location | |||||||||
| Address1: | 2874 N CARSON ST | ||||||||
| Address2: | SUITE 135 | ||||||||
| City: | CARSON CITY | ||||||||
| State: | NV | ||||||||
| PostalCode: | 897060177 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7758837855 | ||||||||
| FaxNumber: | 7758836531 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/01/2007 | ||||||||
| LastUpdateDate: | 10/01/2007 | ||||||||
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| AuthorizedOfficialLastName: | RICKS | ||||||||
| AuthorizedOfficialFirstName: | BRYAN | ||||||||
| AuthorizedOfficialMiddleName: | L. | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7758842455 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 9435 | NV | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine | 207Q00000X | 9435 | NV | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.