MEDICARE: THEODORE NASIOTIS 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	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1407838212
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THEODORE NASIOTIS PA

Provider Business Mailing Address
First Line	:	300 W CENTRAL TEXAS EXPY
Second Line	:	SUITE 115
City	:	HARKER HEIGHTS
State	:	TX
Zip	:	76548-1885
Country	:	US
Telephone Number	:	254-833-8456
Fax Number	:	254-833-9162

Provider Business Practice Location Address
First Line	:	300 W CENTRAL TEXAS EXPY
Second Line	:	SUITE 115
City	:	HARKER HEIGHTS
State	:	TX
Zip	:	76548-1885
Country	:	US
Telephone Number	:	254-833-8456
Fax Number	:	254-833-9162

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

Provider Enumeration Date	:	11/17/2005
Last Update Date	:	12/01/2013

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