Basic Information
Provider Information
NPI: 1003010661
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: DEFILIPPIS
FirstName: NICHOLAS
MiddleName: JAMES
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2411 FOUNTAIN VIEW DR
Address2:  
City: HOUSTON
State: TX
PostalCode: 770574817
CountryCode: US
TelephoneNumber: 7136204000
FaxNumber:  
Practice Location
Address1: 2411 FOUNTAIN VIEW DR
Address2:  
City: HOUSTON
State: TX
PostalCode: 770574817
CountryCode: US
TelephoneNumber: 7136204000
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/14/2007
LastUpdateDate: 11/30/2010
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207L00000XN2467TXY Allopathic & Osteopathic PhysiciansAnesthesiology 
207L00000XBP1-0022040TXN Allopathic & Osteopathic PhysiciansAnesthesiology 

ID Information
IDTypeStateIssuerDescription
20694520205TX MEDICAID
8CL01801TXBLUE CROSS BLUE SHIELDOTHER
279525176201 MYUTMB 2795251762-COMMERCIAL NUMBEROTHER


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