Individual
DR. ROBERT R NYSTROM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1900 16TH ST, GREELEY, CO 80631-5114
(970) 350-2471
(970) 350-2418
Mailing address
1900 16TH ST, GREELEY, CO 80631-5114
(970) 350-2471
(970) 350-2418
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
30464
CO
208D00000X
General Practice Physician
Primary
30464
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1304641
—
CO
01
—
P00931173
MEDICARE RAILROAD CARRIER PTAN
CO
Enumeration date
03/06/2007
Last updated
05/02/2012
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