Provider Demographics
NPI:1255301453
Name:BROOKHYSER, JOAN D (MD)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:D
Last Name:BROOKHYSER
Suffix:
Gender:F
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:PO BOX 371353
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89137-1353
Mailing Address - Country:US
Mailing Address - Phone:702-233-9222
Mailing Address - Fax:702-804-1349
Practice Address - Street 1:10300 W CHARLESTON BLVD STE 13-342
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89135-1037
Practice Address - Country:US
Practice Address - Phone:702-233-9222
Practice Address - Fax:702-804-1349
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2010-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV4227208M00000X, 207RN0300X, 207R00000X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV38451Medicare PIN
NVBZ407ZMedicare PIN