Provider Demographics
NPI:1437318409
Name:ALDER, BRIAN DOUGLAS (MD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:DOUGLAS
Last Name:ALDER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3575 PECOS MCLEOD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121-3803
Mailing Address - Country:US
Mailing Address - Phone:702-202-4776
Mailing Address - Fax:702-202-6110
Practice Address - Street 1:3575 PECOS MCLEOD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-3803
Practice Address - Country:US
Practice Address - Phone:702-731-2088
Practice Address - Fax:702-734-7836
Is Sole Proprietor?:No
Enumeration Date:2008-06-05
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME115147207W00000X
UT11672709-1205207W00000X
NCTBD207W00000X
NV15185207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1437318409Medicaid