=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134325871
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MARK C. NAHMIAS, DPM, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/21/2007
-----------------------------------------------------
Last Update Date | 08/26/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5906 E 31ST ST SUITE 1
-----------------------------------------------------
City | TULSA
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74135-5110
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-749-9996
-----------------------------------------------------
Fax | 918-622-9998
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5906 E 31ST ST SUITE 1
-----------------------------------------------------
City | TULSA
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74135-5110
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-749-9996
-----------------------------------------------------
Fax | 918-622-9998
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. MARK CHARLES NAHMIAS
-----------------------------------------------------
Credential | DPM
-----------------------------------------------------
Telephone | 918-749-9996
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213E00000X
-----------------------------------------------------
Taxonomy Name | Podiatrist
-----------------------------------------------------
License Number | 166
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------