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General NPI Number Information
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NPI Number | 1609296037
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Entity Type | Organization
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Legal Business Name | HUGO C. NIEVAS, MD, PA
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Dates
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Enumeration Date | 04/24/2014
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Last Update Date | 06/09/2015
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Provider Practice Location Address
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Address Line | 1017 44TH AVE
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City | GULFPORT
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State | MS
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Zip | 39501-2547
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Country | US
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Telephone | 228-860-3467
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1628
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City | GULFPORT
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State | MS
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Zip | 39502-1628
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Country | US
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Telephone | 228-860-3467
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Fax | 985-643-9808
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Authorized Official
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Title or Position | OWNER/AUTHORIZED AGENT
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Name | HUGO CARLOS NIEVAS
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Credential | M.D.
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Telephone | 228-860-3467
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 08451
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License Number State | MS
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