Individual
JACK A NUSZEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
6565 FANNIN ST, SUITE M 196, HOUSTON, TX 77030-2703
(713) 790-3311
Mailing address
PO BOX 24125, FORT WORTH, TX 76124-1125
(817) 451-4208
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
K3811
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
118503510
—
TX
05
—
118503512
—
TX
01
—
8P5339
BLUE CROSS & BLUE SHIELD
TX
01
—
P00174597
RAIL ROAD MEDICARE
TX
01
—
P00311999
RAIL ROAD MEDICARE
TX
Enumeration date
10/18/2006
Last updated
11/07/2007
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