Provider Demographics
NPI:1639128705
Name:NIETRZEBA, RALPH M (MD)
Entity Type:Individual
Prefix:
First Name:RALPH
Middle Name:M
Last Name:NIETRZEBA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:400 N STEPHANIE ST STE 300
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89014-6692
Mailing Address - Country:US
Mailing Address - Phone:702-952-3350
Mailing Address - Fax:702-952-3365
Practice Address - Street 1:9280 W SUNSET RD STE 312
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-4862
Practice Address - Country:US
Practice Address - Phone:702-737-5864
Practice Address - Fax:702-737-6885
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2024-03-21
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Provider Licenses
StateLicense IDTaxonomies
NV4554207RP1001X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV2002875Medicaid
NV2002875Medicaid
V110456Medicare PIN
29WCGZG04Medicare ID - Type Unspecified