Provider Demographics
NPI:1982164612
Name:NEBZYDOSKI, CHRISTOPHER HENRY (DO)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:HENRY
Last Name:NEBZYDOSKI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:633 GOVERNOR CARLOS CAMACHO ROAD
Mailing Address - Street 2:
Mailing Address - City:TAMUNING
Mailing Address - State:GU
Mailing Address - Zip Code:96931
Mailing Address - Country:US
Mailing Address - Phone:671-649-1001
Mailing Address - Fax:
Practice Address - Street 1:633 GOVERNOR CARLOS CAMACHO ROAD
Practice Address - Street 2:
Practice Address - City:TAMUNING
Practice Address - State:GU
Practice Address - Zip Code:96931
Practice Address - Country:US
Practice Address - Phone:671-649-1001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-20
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GUDO-0132208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty