Provider Demographics
NPI:1922116771
Name:CITRO, BRIAN J (MD)
Entity Type:Individual
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First Name:BRIAN
Middle Name:J
Last Name:CITRO
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Gender:M
Credentials:MD
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Mailing Address - Street 1:7375 PRAIRIE FALCON RD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-0810
Mailing Address - Country:US
Mailing Address - Phone:702-648-9400
Mailing Address - Fax:702-636-0249
Practice Address - Street 1:7375 PRAIRIE FALCON RD
Practice Address - Street 2:SUITE 150
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-0810
Practice Address - Country:US
Practice Address - Phone:702-648-9400
Practice Address - Fax:702-636-0249
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2020-02-11
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Provider Licenses
StateLicense IDTaxonomies
NV11968208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100518547Medicaid