Individual
DR. YUDI WIBISONO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
6900 N PECOS RD, NORTH LAS VEGAS, NV 89086-4400
(702) 791-9000
Mailing address
6900 N PECOS RD, NORTH LAS VEGAS, NV 89086-4400
(702) 791-9000
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
MRO-1647
ID
2083P0500X
Preventive Medicine/Occupational Environmental Medicine Physician
MRO-1647
ID
2083X0100X
Occupational Medicine Physician
10964114-1204
UT
2083X0100X
Occupational Medicine Physician
Primary
OP61182777
WA
Other
Enumeration date
03/27/2017
Last updated
10/13/2022
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