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General NPI Number Information
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NPI Number | 1952571036
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Entity Type | Organization
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Legal Business Name | GRANT NITZEL MD PLLC
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Dates
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Enumeration Date | 03/05/2008
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Last Update Date | 05/07/2009
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Provider Practice Location Address
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Address Line | 701 S 1ST ST
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City | MULESHOE
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State | TX
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Zip | 79347-3626
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Country | US
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Telephone | 806-272-7531
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Fax | 806-272-4749
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Provider Business Mailing Address
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Address Line | PO BOX 404
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City | MULESHOE
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State | TX
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Zip | 79347-0404
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Country | US
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Telephone | 806-272-3040
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Fax | 806-272-3115
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Authorized Official
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Title or Position | MD
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Name | GRANT EUGENE NITZEL
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Credential | MD
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Telephone | 806-272-3040
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | M5412
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License Number State | TX
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