Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 11886 | NV |
Y | 207XS0106X | Orthopaedic Hand Surgeon | 11886 | NV |
NPI | 1124050307 |
---|---|
Provider Name | Dr. Ryan J Grabow |
First Address | Henderson, NV 89053-1162 |
Second Address | Henderson, NV 89052-3506 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2006 |
Last Update Date | 28/02/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
11886 | MEDICAL LICENSE (01) | NV |
I61099 | (02) | NV |