Individual
PERRY G NYSTROM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4100 W 3RD ST, DAYTON, OH 45428-9000
(937) 268-6511
(937) 267-3917
Mailing address
4100 W 3RD ST, DAYTON, OH 45428-9000
(937) 268-6511
(937) 267-3917
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
35062875
OH
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
Primary
35062875
OH
207RP1001X
Pulmonary Disease Physician
35062875
OH
Other
Enumeration date
11/09/2005
Last updated
12/17/2013
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