Mark E. Nichols MD PA

Primary specialty

Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X

License

L0457 Issued in TX

Legal business name

MARK E. NICHOLS MD PA

Practice address

18059 Highway 105 W
Suite125
Montgomery, TX 77356-5000

Phone

(936) 582-5666

NPI assigned

Sep 25, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mark E Nichols, MD

Title

Owner

Phone

(936) 582-5666

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1190678400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1232496000000",
    "number": "1891981718",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18059 HIGHWAY 105 W",
            "address_2": "SUITE125",
            "city": "MONTGOMERY",
            "state": "TX",
            "postal_code": "773565000",
            "telephone_number": "936-582-5666"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18059 HIGHWAY 105 W",
            "address_2": "SUITE125",
            "city": "MONTGOMERY",
            "state": "TX",
            "postal_code": "773565000",
            "telephone_number": "936-582-5666"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARK E. NICHOLS MD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-25",
        "last_updated": "2009-01-21",
        "status": "A",
        "authorized_official_last_name": "NICHOLS",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "936-582-5666",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": "TX",
            "license": "L0457",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "0042MP",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "174211601",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Obstetrics & Gynecology Physician in Montgomery, TX
• Providers in Montgomery, TX by specialty
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.