# MR. ROBERT GREGORY NYDAM

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1184867301
- **Gender:** Man
- **Credential:** IDMT

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1710I1003X | Independent Duty Medical Technicians | — | NULL | — |
| 363A00000X | Physician Assistant | — | NV | Yes |

## Other

- **Enumeration date:** 04/17/2009
- **Last updated:** 01/23/2017

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1184867301 | — | NV |