Provider Demographics
NPI:1982677365
Name:NYMAN, ERIC B (MD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:B
Last Name:NYMAN
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 1:2175 N ALMA SCHOOL RD
Mailing Address - Street 2:STE C104
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-2879
Mailing Address - Country:US
Mailing Address - Phone:480-222-6770
Mailing Address - Fax:480-222-6771
Practice Address - Street 1:2175 N ALMA SCHOOL RD
Practice Address - Street 2:STE C104
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-2879
Practice Address - Country:US
Practice Address - Phone:480-222-6770
Practice Address - Fax:480-222-6771
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ30125208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ726672Medicaid