Provider Demographics
NPI:1952571036
Name:GRANT NITZEL MD PLLC
Entity Type:Organization
Organization Name:GRANT NITZEL MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:GRANT
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:NITZEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:806-272-3040
Mailing Address - Street 1:PO BOX 404
Mailing Address - Street 2:
Mailing Address - City:MULESHOE
Mailing Address - State:TX
Mailing Address - Zip Code:79347-0404
Mailing Address - Country:US
Mailing Address - Phone:806-272-3040
Mailing Address - Fax:806-272-3115
Practice Address - Street 1:701 S 1ST ST
Practice Address - Street 2:
Practice Address - City:MULESHOE
Practice Address - State:TX
Practice Address - Zip Code:79347-3626
Practice Address - Country:US
Practice Address - Phone:806-272-7531
Practice Address - Fax:806-272-4749
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-05
Last Update Date:2009-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM5412207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00Y775Medicare PIN