Organization
MARK E. NICHOLS MD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK E NICHOLS MD (OWNER)
(936) 582-5666
Entity
Organization
Contact information
Practice address
18059 HIGHWAY 105 W, SUITE125, MONTGOMERY, TX 77356-5000
(936) 582-5666
Mailing address
18059 HIGHWAY 105 W, SUITE125, MONTGOMERY, TX 77356-5000
(936) 582-5666
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
L0457
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0042MP
BCBS
—
05
—
174211601
—
TX
Enumeration date
09/25/2007
Last updated
01/21/2009
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