Individual
MR. BRODERIC D IVERY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1915 ONA MARIE AVE, NORTH LAS VEGAS, NV 89032-4866
(702) 812-4973
(702) 631-6312
Mailing address
1915 ONA MARIE AVE, NORTH LAS VEGAS, NV 89032-4866
(702) 812-4973
(702) 631-6312
Taxonomy
Speciality
Code
Description
License number
State
225400000X
Rehabilitation Practitioner
Primary
—
NV
Other
Enumeration date
03/07/2013
Last updated
03/07/2013
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