Provider Demographics
NPI:1770004004
Name:NICANORD, ERNST JOSEPH (MD)
Entity Type:Individual
Prefix:
First Name:ERNST
Middle Name:JOSEPH
Last Name:NICANORD
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 1:301 UNIVERSITY BLVD
Mailing Address - Street 2:
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77555-1250
Mailing Address - Country:US
Mailing Address - Phone:409-744-4030
Mailing Address - Fax:409-740-4187
Practice Address - Street 1:301 UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77555-1250
Practice Address - Country:US
Practice Address - Phone:409-744-4030
Practice Address - Fax:409-740-4187
Is Sole Proprietor?:No
Enumeration Date:2017-06-27
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS8619207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine