Healthcare Provider Details

I. General information

NPI: 1962619650
Provider Name (Legal Business Name): MR. HERMAN C. NAILS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5121 SHREVEPORT BLVD
HOUSTON TX
77028-3701
US

IV. Provider business mailing address

5121 SHREVEPORT BLVD PO BOX 524101
HOUSTON TX
77028-3701
US

V. Phone/Fax

Practice location:
  • Phone: 713-635-1475
  • Fax: 713-635-5463
Mailing address:
  • Phone: 713-635-1475
  • Fax: 713-635-5463

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code177F00000X
TaxonomyLodging Provider
License Number102199
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: