Provider Demographics
NPI:1639669567
Name:ROY, NERVIK (DO)
Entity type:Individual
Prefix:DR
First Name:NERVIK
Middle Name:
Last Name:ROY
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 1:2545 S BRUCE ST STE 200
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89169-1778
Mailing Address - Country:US
Mailing Address - Phone:702-732-2438
Mailing Address - Fax:702-737-5043
Practice Address - Street 1:1581 MOUNT MARIAH DR STE 150
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-1506
Practice Address - Country:US
Practice Address - Phone:702-851-7766
Practice Address - Fax:702-851-7760
Is Sole Proprietor?:No
Enumeration Date:2018-05-16
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVSL1342207R00000X
NVDO2871208D00000X
COTL.0008760390200000X
NVDO3366207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1639669567Medicaid