Provider Demographics
NPI:1902867062
Name:NUNN, HOWARD S JR (MD)
Entity Type:Individual
Prefix:
First Name:HOWARD
Middle Name:S
Last Name:NUNN
Suffix:JR
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 1:11 CYPRESS PT
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79124-4910
Mailing Address - Country:US
Mailing Address - Phone:806-683-1153
Mailing Address - Fax:
Practice Address - Street 1:11 CYPRESS PT
Practice Address - Street 2:STE 2050
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79124-4910
Practice Address - Country:US
Practice Address - Phone:806-683-1153
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2015-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE33862085R0202X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
120550100OtherFIRSTCARE
OK100249900AMedicaid
TX8A7861OtherBLUE CROSS
TXMDE3386OtherWORKERS COMPENSATION
TX144725203Medicaid
NM33803Medicaid
TX8A7861OtherBLUE CROSS
300126157Medicare ID - Type UnspecifiedRAILROAD MEDICARE
NM33803Medicaid
TX8F7896Medicare PIN
120550100OtherFIRSTCARE