MEDICARE: NICHOLAS B CREEL M.D. ,PA.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	E1833	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215931613
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICHOLAS B CREEL M.D. ,PA.

Provider Business Mailing Address
First Line	:	215 OAK DR S
Second Line	:	STE A
City	:	LAKE JACKSON
State	:	TX
Zip	:	77566-5617
Country	:	US
Telephone Number	:	979-297-1241
Fax Number	:	979-297-5692

Provider Business Practice Location Address
First Line	:	215 OAK DR S
Second Line	:	STE A
City	:	LAKE JACKSON
State	:	TX
Zip	:	77566-5617
Country	:	US
Telephone Number	:	979-297-1241
Fax Number	:	979-297-5692

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/13/2005
Last Update Date	:	01/04/2012

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