Basic Information
| Provider Information | |||||||||
| NPI: | 1225028491 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NOLLA | ||||||||
| FirstName: | JOSE | ||||||||
| MiddleName: | MIGUEL | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11511 SHADOW CREEK PKWY | ||||||||
| Address2: | |||||||||
| City: | PEARLAND | ||||||||
| State: | TX | ||||||||
| PostalCode: | 775847298 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7134420000 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2727 W HOLCOMBE BLVD | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770251669 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7134420000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/27/2005 | ||||||||
| LastUpdateDate: | 04/28/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/28/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | M2732 | TX | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207XS0106X | M2732 | TX | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Hand Surgery | 2086S0105X | M2732 | TX | Y | Allopathic & Osteopathic Physicians | Surgery | Surgery of the Hand |
ID Information
| ID | Type | State | Issuer | Description | 8P5576 | 01 | TX | BCBS TEXAS | OTHER | 181515101 | 05 | TX | MEDICAID |