Provider Demographics
NPI:1023393790
Name:FREDERICK B NIEGOS MDPA
Entity Type:Organization
Organization Name:FREDERICK B NIEGOS MDPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:B
Authorized Official - Last Name:NIEGOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:361-574-1870
Mailing Address - Street 1:2700 CITIZENS PLAZA, SUITE 206
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77901
Mailing Address - Country:US
Mailing Address - Phone:361-574-1870
Mailing Address - Fax:361-574-1871
Practice Address - Street 1:2700 CITIZENS PLAZA, SUITE 206
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901
Practice Address - Country:US
Practice Address - Phone:361-574-1870
Practice Address - Fax:361-574-1871
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-13
Last Update Date:2012-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA053344207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty