Provider Demographics
NPI:1104046895
Name:NESIC, J-PHILIP (LSA)
Entity type:Individual
Prefix:DR
First Name:J-PHILIP
Middle Name:
Last Name:NESIC
Suffix:
Gender:M
Credentials:LSA
Other - Prefix:DR
Other - First Name:J-PHILIP
Other - Middle Name:
Other - Last Name:NESIC
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LSA
Mailing Address - Street 1:12423 SANTIAGO COVE LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77041-6040
Mailing Address - Country:US
Mailing Address - Phone:713-896-8040
Mailing Address - Fax:713-896-8040
Practice Address - Street 1:12423 SANTIAGO COVE LN
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77041-6040
Practice Address - Country:US
Practice Address - Phone:713-896-8040
Practice Address - Fax:713-896-8040
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2014-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXSA00312363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical