Provider Demographics
NPI:1154322014
Name:NILE, BRETT JASON (MD)
Entity Type:Individual
Prefix:
First Name:BRETT
Middle Name:JASON
Last Name:NILE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1610 S CHADBOURNE ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76903-8510
Mailing Address - Country:US
Mailing Address - Phone:325-658-5339
Mailing Address - Fax:325-659-8534
Practice Address - Street 1:3101 RIGDECREST LANE
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76904
Practice Address - Country:US
Practice Address - Phone:324-245-4141
Practice Address - Fax:325-245-4009
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL2505207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX111604802Medicaid
TX111604802Medicaid