Provider Demographics
NPI:1669400040
Name:RICKS, BRYAN L (MD)
Entity type:Individual
Prefix:
First Name:BRYAN
Middle Name:L
Last Name:RICKS
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 1:1200 MOUNTIAN ST
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89703-3821
Mailing Address - Country:US
Mailing Address - Phone:775-882-1324
Mailing Address - Fax:775-882-3859
Practice Address - Street 1:1200 MOUNTIAN ST
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89703-3821
Practice Address - Country:US
Practice Address - Phone:775-882-1324
Practice Address - Fax:775-882-3859
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV9435207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002013484Medicaid
NV002013484Medicaid
V33763Medicare ID - Type Unspecified