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General NPI Number Information
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NPI Number | 1891981718
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Entity Type | Organization
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Legal Business Name | MARK E. NICHOLS MD PA
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Dates
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Enumeration Date | 09/25/2007
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Last Update Date | 01/21/2009
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Provider Practice Location Address
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Address Line | 18059 HIGHWAY 105 W SUITE125
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City | MONTGOMERY
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State | TX
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Zip | 77356-5000
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Country | US
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Telephone | 936-582-5666
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Fax |
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Provider Business Mailing Address
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Address Line | 18059 HIGHWAY 105 W SUITE125
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City | MONTGOMERY
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State | TX
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Zip | 77356-5000
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Country | US
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Telephone | 936-582-5666
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MARK E NICHOLS
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Credential | MD
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Telephone | 936-582-5666
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | L0457
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License Number State | TX
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