Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 0101257601 | VA |
Y | 2080P0208X | Pediatric Infectious Diseases | R9846 | TX |
NPI | 1407118573 |
---|---|
Provider Name | Nicholas Scott Rister |
First Address | Dallas, TX 75373-3784 |
Second Address | Fort Worth, TX 76104-2710 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2012 |
Last Update Date | 06/04/2021 |