Basic Information
| Provider Information | |||||||||
| NPI: | 1497169213 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SAM | ||||||||
| FirstName: | NEVINSON | ||||||||
| MiddleName: | PRADEEP | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 301 UNIVERSITY BLVD # 2-A | ||||||||
| Address2: | |||||||||
| City: | GALVESTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 775550591 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4097721221 | ||||||||
| FaxNumber: | 4097721224 | ||||||||
| Practice Location | |||||||||
| Address1: | 3957 E COVELL RD | ||||||||
| Address2: | |||||||||
| City: | EDMOND | ||||||||
| State: | OK | ||||||||
| PostalCode: | 730346909 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4052857246 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/19/2014 | ||||||||
| LastUpdateDate: | 08/02/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 6588 | OK | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207LP2900X | 6588 | OK | Y | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine |
No ID Information.