Provider Demographics
NPI:1164677944
Name:DAVIS, BRIAN NEIL (MD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:NEIL
Last Name:DAVIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1350 STARDUST ST STE D
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89503-4264
Mailing Address - Country:US
Mailing Address - Phone:775-746-3400
Mailing Address - Fax:
Practice Address - Street 1:1350 STARDUST ST
Practice Address - Street 2:SUITE D
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89503-4264
Practice Address - Country:US
Practice Address - Phone:775-746-3400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-20
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYR1729207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology