Individual
DR. BRENT G NICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
801 E WHITESTONE BLVD STE C, CEDAR PARK, TX 78613-7558
(512) 259-3467
Mailing address
6210 E HIGHWAY 290, AUSTIN, TX 78723-1142
(512) 483-9596
(512) 406-6216
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
Q8978
TX
2080A0000X
Pediatric Adolescent Medicine Physician
019461
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
049405602
—
TX
05
—
049405603
—
TX
05
—
1901806
—
LA
Enumeration date
08/10/2005
Last updated
03/22/2021
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