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MR. ROBERT GREGORY NYDAM IDMT NPI 1184867301


NPI Information

NPI: 1184867301
Provider Name: MR. ROBERT GREGORY NYDAM, IDMT
Classification: Physician Assistant - 363A00000X
Entity Type: Individual

PECOS Registration: Yes

Address:
888 S RANCHO DR
LAS VEGAS, NV
ZIP 89106
Phone: (702) 877-8600
Get Directions

MR. Robert Gregory Nydam, IDMT is a physician assistant in Las Vegas, NV. The provider is a physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. MR. Robert Gregory Nydam, IDMT NPI is 1184867301. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

888 S RANCHO DR
LAS VEGAS, NV
ZIP 89106-810
Phone: (702) 877-8600
Fax: (702) 258-6152

The NPI 1184867301 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 4/17/2009 and was last updated on 1/23/2017.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1363A00000XPhysician AssistantNEVADAYes
21710I1003XMilitary Health Care ProviderIndependent Duty Medical TechniciansNo

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
11184867301MEDICAIDNEVADA
2V112613MEDICARE PINNEVADA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.