Basic Information
| Provider Information | |||||||||
| NPI: | 1861594509 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SAKOW | ||||||||
| FirstName: | NOLAN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 4342 | ||||||||
| Address2: | |||||||||
| City: | HORSESHOE BAY | ||||||||
| State: | TX | ||||||||
| PostalCode: | 786574342 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8305981745 | ||||||||
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| Practice Location | |||||||||
| Address1: | 540 JETT DR | ||||||||
| Address2: | |||||||||
| City: | JACKSON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 413399622 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6066666000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/02/2006 | ||||||||
| LastUpdateDate: | 11/22/2016 | ||||||||
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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 | 2085N0904X | 25501 | KY | N | Allopathic & Osteopathic Physicians | Radiology | Nuclear Radiology | 208D00000X | 25501 | KY | Y | Allopathic & Osteopathic Physicians | General Practice |
ID Information
| ID | Type | State | Issuer | Description | 64255011 | 05 | KY | MEDICAID |