Provider Demographics
NPI:1164401642
Name:PAILES, NATHAN A (MD)
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:A
Last Name:PAILES
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 1:14850 QUORUM DR STE 440
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75254-7001
Mailing Address - Country:US
Mailing Address - Phone:694-853-7392
Mailing Address - Fax:469-519-1400
Practice Address - Street 1:14850 QUORUM DR STE 440
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75254-7001
Practice Address - Country:US
Practice Address - Phone:469-437-3564
Practice Address - Fax:469-519-1400
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-12
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL9839207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX167974803Medicaid
TX167974802Medicaid
TX167974801Medicaid
H84736Medicare UPIN
TX8C6177Medicare ID - Type UnspecifiedDALLAS
TX8C6179Medicare ID - Type UnspecifiedMCKINNEY
TX167974802Medicaid
TX167974803Medicaid