Provider Demographics
NPI:1578204657
Name:DOUGLAS, BRIAN DUONG (PA-C)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:DUONG
Last Name:DOUGLAS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:605 SIERRA ROSE DR STE 4
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89511-2093
Mailing Address - Country:US
Mailing Address - Phone:775-689-5410
Mailing Address - Fax:775-451-1713
Practice Address - Street 1:605 SIERRA ROSE DR STE 4
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89511-2093
Practice Address - Country:US
Practice Address - Phone:775-451-1701
Practice Address - Fax:775-451-1713
Is Sole Proprietor?:No
Enumeration Date:2022-04-05
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NVPA2622363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical