Provider Demographics
NPI:1245211754
Name:NIMCHAN, RALPH (MD)
Entity type:Individual
Prefix:
First Name:RALPH
Middle Name:
Last Name:NIMCHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6801 MCPHERSON AVE
Mailing Address - Street 2:SUITE 226
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-6402
Mailing Address - Country:US
Mailing Address - Phone:956-723-0462
Mailing Address - Fax:956-723-6547
Practice Address - Street 1:6801 MCPHERSON AVE
Practice Address - Street 2:SUITE 226
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-6402
Practice Address - Country:US
Practice Address - Phone:956-723-0462
Practice Address - Fax:956-723-6547
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-10
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE3075174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX099912002Medicaid
TXC19913Medicare UPIN
TX099912002Medicaid