Provider Demographics
NPI:1982196416
Name:NISAR, NIDA (DPM)
Entity Type:Individual
Prefix:
First Name:NIDA
Middle Name:
Last Name:NISAR
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 58538
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-8538
Mailing Address - Country:US
Mailing Address - Phone:832-852-8090
Mailing Address - Fax:281-791-0516
Practice Address - Street 1:1917 ASHLAND ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77008-3907
Practice Address - Country:US
Practice Address - Phone:832-852-8090
Practice Address - Fax:281-791-0516
Is Sole Proprietor?:No
Enumeration Date:2018-05-31
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3102213E00000X, 213ES0103X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist