MEDICARE: DR. ERIC DWAYNE NOLEN MD, MBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	P2323	TX

General Provider Information

NPI Number	:	1184870651
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERIC DWAYNE NOLEN MD, MBA

Provider Business Mailing Address
First Line	:	619 RICHMOND AVE
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77006-5509
Country	:	US
Telephone Number	:	832-668-5833
Fax Number	:	832-365-6119

Provider Business Practice Location Address
First Line	:	619 RICHMOND AVE
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77006-5509
Country	:	US
Telephone Number	:	832-668-5833
Fax Number	:	832-365-6119

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/14/2008
Last Update Date	:	11/24/2015

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