Niceler, Brock James

Niceler, Brock James is an individual health care provider with primary practice located at 1600 Providence Dr , Waco TX 76707-2261. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Family Medicine, Allopathic & Osteopathic Physicians / Sports Medicine. Allopathic & Osteopathic Physicians / Sports Medicine is his primary health care specialty. Niceler, Brock James can be contacted via phone (254) 313-4200.

Contact Information

Primary practice address
1600 Providence Dr Waco TX 76707-2261
Phone: (254) 313-4200
Fax: (254) 313-4549
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 2010-01146 North Carolina
Allopathic & Osteopathic Physicians / Sports Medicine 207QS0010X 2010-01146 North Carolina
Allopathic & Osteopathic Physicians / Sports Medicine 207QS0010X S0344 Texas
Allopathic & Osteopathic Physicians / Sports Medicine 207QS0010X 27244 West Virginia

Profile Details

NPI number 1164608113
LBN Legal business name Niceler, Brock James
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 20th, 2008
Last updated Feb 11th, 2019 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1164608113 NPPES
North Carolina MEDICAID 5915411
North Carolina Other 159H0

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