Provider Demographics
NPI:1104882166
Name:BURLEW, BRAD S (MD)
Entity type:Individual
Prefix:DR
First Name:BRAD
Middle Name:S
Last Name:BURLEW
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 1:1775 BROWNING WAY STE 104
Mailing Address - Street 2:
Mailing Address - City:ELKO
Mailing Address - State:NV
Mailing Address - Zip Code:89801-8338
Mailing Address - Country:US
Mailing Address - Phone:775-738-5100
Mailing Address - Fax:775-738-5115
Practice Address - Street 1:1775 BROWNING WAY STE 104
Practice Address - Street 2:
Practice Address - City:ELKO
Practice Address - State:NV
Practice Address - Zip Code:89801-8338
Practice Address - Country:US
Practice Address - Phone:775-738-5100
Practice Address - Fax:775-738-5115
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-26
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV13818207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
A98517Medicare UPIN