Provider Demographics
NPI:1033101639
Name:BRYAN, RICHARD H JR (MD05)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:H
Last Name:BRYAN
Suffix:JR
Gender:M
Credentials:MD05
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:645 N ARLINGTON AVE STE 555
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89503-4452
Mailing Address - Country:US
Mailing Address - Phone:775-770-7622
Mailing Address - Fax:775-770-3683
Practice Address - Street 1:645 N ARLINGTON AVE STE 555
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89503
Practice Address - Country:US
Practice Address - Phone:775-770-7622
Practice Address - Fax:775-770-3683
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG83382207RC0000X
NV7744207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV2016561Medicaid
NV37214Medicare PIN
NV2016561Medicaid
NVG09858Medicare UPIN