Provider Demographics
NPI:1124050307
Name:GRABOW, RYAN J (MD)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:J
Last Name:GRABOW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 531162
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89053-1162
Mailing Address - Country:US
Mailing Address - Phone:702-433-9533
Mailing Address - Fax:702-478-9452
Practice Address - Street 1:3175 SAINT ROSE PKWY
Practice Address - Street 2:SUITE 330
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-3506
Practice Address - Country:US
Practice Address - Phone:702-433-9533
Practice Address - Fax:702-478-9542
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2019-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV11886207XS0106X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV11886OtherMEDICAL LICENSE
NVI61099Medicare UPIN
NV102652Medicare PIN
NV102652Medicare ID - Type UnspecifiedMEDICARE NUMBER