Provider Demographics
NPI:1851381081
Name:JUELL, BRIAN E (MD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:E
Last Name:JUELL
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 1:6554 S MCCARRAN BLVD
Mailing Address - Street 2:#B
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-6166
Mailing Address - Country:US
Mailing Address - Phone:775-324-0288
Mailing Address - Fax:775-323-5504
Practice Address - Street 1:6554 S MCCARRAN BLVD
Practice Address - Street 2:#B
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-6112
Practice Address - Country:US
Practice Address - Phone:775-324-0288
Practice Address - Fax:775-323-5504
Is Sole Proprietor?:No
Enumeration Date:2005-10-27
Last Update Date:2012-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV5075208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV2016173Medicaid
C96203Medicare UPIN
NVVMD5075Medicare ID - Type Unspecified