Individual
JEFFREY M NIEMANN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1367 DOMINION PLZ, TYLER, TX 75703-1013
(903) 534-6200
Mailing address
1367 DOMINION PLZ, TYLER, TX 75703-1013
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
K7360
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
070015117
RAILROAD MEDICARE PTAN
TX
05
—
117712302
—
TX
01
—
8A2680
BLUE CROSS AND BLUE SHIELD
TX
Enumeration date
07/02/2006
Last updated
05/22/2008
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