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Individual

DR. BROCK JAMES NICELER

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
1600 PROVIDENCE DR, WACO, TX 76707-2261
(254) 313-4200
(254) 313-4549
Mailing address
1600 PROVIDENCE DR, WACO, TX 76707-2261
(254) 313-4200
(254) 313-4549

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
2010-01146
NC
207QS0010X
Sports Medicine (Family Medicine) Physician
2010-01146
NC
207QS0010X
Sports Medicine (Family Medicine) Physician
27244
WV
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
S0344
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
159H0
BCBSNC
NC
05
5915411
NC
Enumeration date
01/20/2008
Last updated
02/11/2019
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