Provider Demographics
NPI:1770874539
Name:BRYAN CHALLAPALLI AND BAKER, A PROFESSIONAL MEDICAL CORPORATION
Entity type:Organization
Organization Name:BRYAN CHALLAPALLI AND BAKER, A PROFESSIONAL MEDICAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:HUDSON
Authorized Official - Last Name:BRYAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:775-785-9202
Mailing Address - Street 1:PO BOX 30033
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89520-3033
Mailing Address - Country:US
Mailing Address - Phone:775-785-9202
Mailing Address - Fax:775-823-3066
Practice Address - Street 1:75 PRINGLE WAY
Practice Address - Street 2:SUITE 401
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-1464
Practice Address - Country:US
Practice Address - Phone:775-688-8000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-28
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty