Provider Demographics
NPI:1386842938
Name:BROSIOUS, JOHN PATRICK (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:PATRICK
Last Name:BROSIOUS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JOHN
Other - Middle Name:PATRICK
Other - Last Name:BROSIOUS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:341 N BUFFALO DR STE B
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89145-0376
Mailing Address - Country:US
Mailing Address - Phone:702-727-8500
Mailing Address - Fax:702-444-2461
Practice Address - Street 1:341 N BUFFALO DR STE B
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89145-0376
Practice Address - Country:US
Practice Address - Phone:702-727-8500
Practice Address - Fax:702-444-2461
Is Sole Proprietor?:No
Enumeration Date:2007-07-05
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD447430208200000X
NV16256208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV16256OtherLICENSE
PAMD447430OtherLICENSE NUMBER
NV16256OtherLICENSE