Healthcare Provider Details

I. General information

NPI: 1972598837
Provider Name (Legal Business Name): JOHN E NIX MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2005
Last Update Date: 12/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 GALLERIA OAKS DR
TEXARKANA TX
75503-4625
US

IV. Provider business mailing address

2101 GALLERIA OAKS DR
TEXARKANA TX
75503-4625
US

V. Phone/Fax

Practice location:
  • Phone: 903-791-9120
  • Fax: 903-791-9132
Mailing address:
  • Phone: 903-614-5950
  • Fax: 903-614-5955

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberK7362
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: