Provider Demographics
NPI:1972598837
Name:NIX, JOHN E (MD)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:E
Last Name:NIX
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2101 GALLERIA OAKS DR
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75503-4625
Mailing Address - Country:US
Mailing Address - Phone:903-614-5950
Mailing Address - Fax:903-614-5955
Practice Address - Street 1:2101 GALLERIA OAKS DR
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-4625
Practice Address - Country:US
Practice Address - Phone:903-791-9120
Practice Address - Fax:903-791-9132
Is Sole Proprietor?:No
Enumeration Date:2005-09-16
Last Update Date:2018-12-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXK7362207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4995690001OtherCIGNA GOVERNMENT SERVICES
TX042151304Medicaid
TX042151304Medicaid
F74654Medicare UPIN