Provider Demographics
NPI:1316927452
Name:LAUF, BRIAN SCOTT (PAC)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:SCOTT
Last Name:LAUF
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5070 ION DR
Mailing Address - Street 2:#A
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89436-1675
Mailing Address - Country:US
Mailing Address - Phone:775-354-0200
Mailing Address - Fax:775-354-0211
Practice Address - Street 1:5070 ION DR
Practice Address - Street 2:#A
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89436-1675
Practice Address - Country:US
Practice Address - Phone:775-354-0200
Practice Address - Fax:775-354-0211
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2010-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV523363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100500979Medicaid
NV37650Medicare ID - Type Unspecified
NV100500979Medicaid