Provider Demographics
NPI:1982850756
Name:EARLEY, BRIAN VICTOR (DO)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:VICTOR
Last Name:EARLEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:6355 S BUFFALO DR FL 3
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-2133
Mailing Address - Country:US
Mailing Address - Phone:702-216-3346
Mailing Address - Fax:702-671-6883
Practice Address - Street 1:1297 BOULDER CITY PKWY STE A
Practice Address - Street 2:
Practice Address - City:BOULDER CITY
Practice Address - State:NV
Practice Address - Zip Code:89005-1854
Practice Address - Country:US
Practice Address - Phone:702-294-1919
Practice Address - Fax:702-294-0072
Is Sole Proprietor?:No
Enumeration Date:2008-08-13
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVSL0607207Q00000X
NVDO1605207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1982850756Medicaid
NVFG733ZMedicare PIN
NVFG733YMedicare PIN