Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | J8333 | TX |
NPI | 1003811415 |
---|---|
Provider Name | Dr. John Francis Nielsen |
First Address | Carthage, TX 75633-1461 |
Second Address | Carthage, TX 75633-1461 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2005 |
Last Update Date | 28/03/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8G9170 | BLUE CROSS (01) | TX |
G01263 | (02) | TX |