Provider Demographics
NPI: | 1952410219 |
---|---|
Name: | VIYUOH, NICHOLAS G (MD) |
Entity Type: | Individual |
Prefix: | |
First Name: | NICHOLAS |
Middle Name: | G |
Last Name: | VIYUOH |
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: | 101 S PARK LN |
Mailing Address - Street 2: | |
Mailing Address - City: | ALTUS |
Mailing Address - State: | OK |
Mailing Address - Zip Code: | 73521-5731 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 580-379-6140 |
Mailing Address - Fax: | 580-379-6149 |
Practice Address - Street 1: | 525 E GRANT ST |
Practice Address - Street 2: | |
Practice Address - City: | MACOMB |
Practice Address - State: | IL |
Practice Address - Zip Code: | 61455-3313 |
Practice Address - Country: | US |
Practice Address - Phone: | 309-836-6937 |
Practice Address - Fax: | 309-836-6530 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-08-30 |
Last Update Date: | 2024-05-08 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
MS | 18368 | 207V00000X |
PA | MD430772 | 207V00000X |
IL | 036153809 | 207V00000X |
OK | 27537 | 207V00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207V00000X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
MS | 00259091 | Medicaid | |
OK | 200278140A | Medicaid | |
AR | 152327001 | Medicaid | |
MS | 00259091 | Medicaid | |
AR | 152327001 | Medicaid | |
OK | 200278140A | Medicaid |