Healthcare Provider Details

I. General information

NPI: 1124050307
Provider Name (Legal Business Name): RYAN J GRABOW M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 02/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3175 SAINT ROSE PKWY SUITE 330
HENDERSON NV
89052-3506
US

IV. Provider business mailing address

PO BOX 531162
HENDERSON NV
89053-1162
US

V. Phone/Fax

Practice location:
  • Phone: 702-433-9533
  • Fax: 702-478-9542
Mailing address:
  • Phone: 702-433-9533
  • Fax: 702-478-9452

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number11886
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number11886
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: