Provider Demographics
NPI:1629035274
Name:NIEVERA, EVERETT (MD)
Entity type:Individual
Prefix:
First Name:EVERETT
Middle Name:
Last Name:NIEVERA
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 1:1201 CALLE MILAGROS
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78526-1361
Mailing Address - Country:US
Mailing Address - Phone:956-544-4700
Mailing Address - Fax:956-544-4774
Practice Address - Street 1:2501 PAREDES LINE RD
Practice Address - Street 2:STE A10
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78526-1193
Practice Address - Country:US
Practice Address - Phone:956-544-4700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-27
Last Update Date:2011-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL0880208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX142274302Medicaid