Provider Demographics
NPI:1487725644
Name:DALY, BRIAN J (MS PA-C)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:J
Last Name:DALY
Suffix:
Gender:M
Credentials:MS PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18653 WEDGE PKWY STE 300
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89511-3007
Mailing Address - Country:US
Mailing Address - Phone:775-770-7210
Mailing Address - Fax:775-770-7211
Practice Address - Street 1:18653 WEDGE PKWY STE 300
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89511-3007
Practice Address - Country:US
Practice Address - Phone:775-770-7210
Practice Address - Fax:775-770-7211
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV530363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV530OtherPHYSICIAN ASSISTANT LIC
NVPENDINGMedicaid
NV1035139OtherNCCPA CERTIFICATION
NV530OtherPHYSICIAN ASSISTANT LIC
NVPENDINGMedicare UPIN