Individual
DR. BRIAN MICHEAL BANTUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1055 ROBERTA LN, #103, SPARKS, NV 89431-2809
(775) 331-2600
(775) 331-2605
Mailing address
1055 ROBERTA LN, #103, SPARKS, NV 89431-2809
(775) 331-2600
(775) 331-2605
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
14341
NV
390200000X
Student in an Organized Health Care Education/Training Program
PAPERWORK IN PROCESS
NV
Other
Enumeration date
03/25/2008
Last updated
05/01/2018
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