Provider Demographics
NPI:1134479199
Name:STEPHENS, NICHOLAI (MD)
Entity Type:Individual
Prefix:
First Name:NICHOLAI
Middle Name:
Last Name:STEPHENS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1140 BUSINESS CENTER DR STE 403
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77043-2743
Mailing Address - Country:US
Mailing Address - Phone:713-935-9758
Mailing Address - Fax:713-467-6209
Practice Address - Street 1:12121 RICHMOND AVE STE 224
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77082-2422
Practice Address - Country:US
Practice Address - Phone:713-935-9758
Practice Address - Fax:713-467-6209
Is Sole Proprietor?:No
Enumeration Date:2012-09-17
Last Update Date:2018-04-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXP9262208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery