MEDICARE: NIZAM M. MEAH MD

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	207RG0100X	Gastroenterology Physician	J5833	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	88581Y	OTHER	TX	BLUE CROSS

General Provider Information

NPI Number	:	1720174857
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NIZAM M. MEAH MD

Provider Business Mailing Address
First Line	:	109 PARKING WAY ST
Second Line	:
City	:	LAKE JACKSON
State	:	TX
Zip	:	77566-5228
Country	:	US
Telephone Number	:	979-292-0033
Fax Number	:	979-292-0488

Provider Business Practice Location Address
First Line	:	109 PARKING WAY ST
Second Line	:
City	:	LAKE JACKSON
State	:	TX
Zip	:	77566-5228
Country	:	US
Telephone Number	:	979-292-0033
Fax Number	:	979-292-0488

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

Provider Enumeration Date	:	10/05/2006
Last Update Date	:	10/17/2007

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