Provider Demographics
NPI:1225175524
Name:CARR, BRIAN JAMES (MD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:JAMES
Last Name:CARR
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 1:12009 VENTO FORTE AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89138
Mailing Address - Country:US
Mailing Address - Phone:702-963-1231
Mailing Address - Fax:702-302-4455
Practice Address - Street 1:9260 W SUNSET RD STE 200
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-4903
Practice Address - Country:US
Practice Address - Phone:702-963-1231
Practice Address - Fax:702-442-9309
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE23730171000000X
NY254960-1207X00000X
NV16690207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No171000000XOther Service ProvidersMilitary Health Care Provider
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1225175524Medicaid