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MR. ROBERT GREGORY NYDAM

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
IDMT

Contact information

Practice address
888 S RANCHO DR, LAS VEGAS, NV 89106-3810
(702) 877-8600
(702) 258-6152
Mailing address
PO BOX 15645, LAS VEGAS, NV 89114-5645
(702) 877-8600
(702) 258-6152

Taxonomy

Speciality
Code
Description
License number
State
1710I1003X
Independent Duty Medical Technicians
363A00000X
Physician Assistant
Primary
NV

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1184867301
NV
Enumeration date
04/17/2009
Last updated
01/23/2017
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