Provider Demographics
NPI:1598764771
Name:BRILL, KEITH ROBERT (MD)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:ROBERT
Last Name:BRILL
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 1:8906 SPANISH RIDGE AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-1319
Mailing Address - Country:US
Mailing Address - Phone:702-330-3102
Mailing Address - Fax:702-912-4994
Practice Address - Street 1:8285 W ARBY AVE STE 280
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89113-2246
Practice Address - Country:US
Practice Address - Phone:702-862-8862
Practice Address - Fax:702-862-8774
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-19
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV10570207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100500309Medicaid
NV1598764771Medicaid
NVV109817Medicare PIN
NV1598764771Medicaid