Provider Demographics
NPI:1942230164
Name:ROWDER, NICHOLAS JAMES (MD)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:JAMES
Last Name:ROWDER
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 1:408 W 45TH ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78751-3014
Mailing Address - Country:US
Mailing Address - Phone:512-451-5800
Mailing Address - Fax:512-459-1399
Practice Address - Street 1:321 W BEN WHITE
Practice Address - Street 2:STE 205
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-7087
Practice Address - Country:US
Practice Address - Phone:512-451-5800
Practice Address - Fax:512-459-1399
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2015-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM4494207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX181948402Medicaid
TX181948402Medicaid
TXI19370Medicare UPIN
TX10070585OtherAMERIGROUP
TX8G7400Medicare PIN