Most Relevant Information
Provider Data
| NPI Number: | 1003058819 |
| Provider Name: | HIRUT NICODIMOS |
| Entity Type: | Individual |
| Taxonomy Code: | 363AS0400X |
| Specialty: | Physician Assistant |
| License Number: | PA06188 |
Most Important Dates
| Enumeration Date: | 03/26/2009 |
| Last Updated: | 03/08/2013 |
Provider Practice Location
302 UNIVERSITY BLVD
ROUND ROCK
TX
786651032
Practice Location Phone/Fax
| Phone: | 5125090200 |
| Fax: |
Provider Mailing Location
302 UNIVERSITY BLVD
ROUND ROCK
TX
786651032
Provider Mailing Phone/Fax
| Phone: | 5125090200 |
| Fax: |