Provider Demographics
NPI:1184870651
Name:NOLEN, ERIC DWAYNE (MD, MBA)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:DWAYNE
Last Name:NOLEN
Suffix:
Gender:M
Credentials:MD, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:619 RICHMOND AVE
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77006-5509
Mailing Address - Country:US
Mailing Address - Phone:832-668-5833
Mailing Address - Fax:832-365-6119
Practice Address - Street 1:619 RICHMOND AVE
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77006-5509
Practice Address - Country:US
Practice Address - Phone:832-668-5833
Practice Address - Fax:832-365-6119
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-14
Last Update Date:2015-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP2323207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine