Provider Demographics
NPI:1679559751
Name:TWOMBLY, CHRISTOPHER D (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:D
Last Name:TWOMBLY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6630 S MCCARRAN BLVD
Mailing Address - Street 2:SUITE A4
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-6135
Mailing Address - Country:US
Mailing Address - Phone:775-828-2873
Mailing Address - Fax:775-828-2889
Practice Address - Street 1:6630 S MCCARRAN BLVD
Practice Address - Street 2:SUITE A4
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-6135
Practice Address - Country:US
Practice Address - Phone:775-828-2873
Practice Address - Fax:775-828-2889
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2010-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV9733208VP0014X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV11042082OtherCAQH
NV002016900Medicaid
NVV34947Medicare PIN
NV002016900Medicaid