Provider Demographics
NPI:1033181813
Name:NIKOLAIDIS, GREGORY A
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:A
Last Name:NIKOLAIDIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8825 BEE CAVE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746-4719
Mailing Address - Country:US
Mailing Address - Phone:512-328-3376
Mailing Address - Fax:512-666-3767
Practice Address - Street 1:8825 BEE CAVE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-4719
Practice Address - Country:US
Practice Address - Phone:512-328-3376
Practice Address - Fax:512-399-6895
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2019-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL3414207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8347B6OtherBCBS OF TEXAS INDIVIDUAL #
TX8347B6Medicare PIN
TXH07754Medicare UPIN
TX8347B6OtherBCBS OF TEXAS INDIVIDUAL #
00440ZMedicare PIN