Individual
JOHN NYSTROM
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
504 21ST ST, GLENWOOD SPRINGS, CO 81601-4287
(970) 945-7564
(970) 945-0563
Mailing address
PO BOX 2010, GLENWOOD SPRINGS, CO 81602-2010
(970) 945-7564
(970) 945-0563
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
21797
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01217975
—
CO
Enumeration date
05/20/2006
Last updated
07/08/2007
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