Provider Demographics
NPI:1598910481
Name:SOUDER, NICHOLAS (MD)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:
Last Name:SOUDER
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 1:1001 US HIGHWAY 83 N
Mailing Address - Street 2:
Mailing Address - City:CHILDRESS
Mailing Address - State:TX
Mailing Address - Zip Code:79201-2322
Mailing Address - Country:US
Mailing Address - Phone:940-937-9654
Mailing Address - Fax:940-937-9644
Practice Address - Street 1:1001 US HIGHWAY 83 N
Practice Address - Street 2:
Practice Address - City:CHILDRESS
Practice Address - State:TX
Practice Address - Zip Code:79201-2322
Practice Address - Country:US
Practice Address - Phone:940-937-9654
Practice Address - Fax:940-937-9644
Is Sole Proprietor?:No
Enumeration Date:2008-11-19
Last Update Date:2013-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN6036207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery