Provider Demographics
NPI:1669669990
Name:BRYAN L. RICKS, M.D.
Entity Type:Organization
Organization Name:BRYAN L. RICKS, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:RICKS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:775-884-2455
Mailing Address - Street 1:PO BOX 21530
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89721-1530
Mailing Address - Country:US
Mailing Address - Phone:775-884-2455
Mailing Address - Fax:775-884-0345
Practice Address - Street 1:2874 N CARSON ST
Practice Address - Street 2:SUITE 135
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89706-0177
Practice Address - Country:US
Practice Address - Phone:775-883-7855
Practice Address - Fax:775-883-6531
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-01
Last Update Date:2007-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV9435207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty