Provider Demographics
NPI:1285716142
Name:NAHMIAS, MARK CHARLES (DPM)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:CHARLES
Last Name:NAHMIAS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5906 E 31ST ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-5110
Mailing Address - Country:US
Mailing Address - Phone:918-749-9996
Mailing Address - Fax:918-622-9998
Practice Address - Street 1:5906 E 31ST ST
Practice Address - Street 2:SUITE 1
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-5110
Practice Address - Country:US
Practice Address - Phone:918-749-9996
Practice Address - Fax:918-622-9998
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK166213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
T14987Medicare UPIN
OK243404901Medicare ID - Type UnspecifiedINDIVIDUAL