1437372406 NPI number — NICK NICHOLSON, M.D., P.A.

Table of content: (NPI 1437372406)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437372406 NPI number — NICK NICHOLSON, M.D., P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NICK NICHOLSON, M.D., P.A.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1437372406
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/08/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5000 LEGACY DR STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PLANO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75024-3373
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-494-3100
Provider Business Mailing Address Fax Number:
972-608-0005

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8080 INDEPENDENCE PKWY
Provider Second Line Business Practice Location Address:
SUITE 115
Provider Business Practice Location Address City Name:
PLANO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75025-4000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-494-3100
Provider Business Practice Location Address Fax Number:
972-487-5646
Provider Enumeration Date:
04/10/2007

Additional Information

Authorized Official

Authorized Official Last Name:
NICHOLSON
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
DANIEL
Authorized Official Title or Position:
GENERAL SURGEON
Authorized Official Telephone Number:
214-213-9120

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  L1953 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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