1861157489 NPI number — DR. DUNCAN ALEXANDER NICKERSON MD, FRCSC

Table of content: DR. DUNCAN ALEXANDER NICKERSON MD, FRCSC (NPI 1861157489)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861157489 NPI number — DR. DUNCAN ALEXANDER NICKERSON MD, FRCSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NICKERSON
Provider First Name:
DUNCAN
Provider Middle Name:
ALEXANDER
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD, FRCSC
Provider Gender Code:
M

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:
1861157489
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/08/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
SUITE 200
Provider Second Line Business Mailing Address:
2004 14TH STREET NW
Provider Business Mailing Address City Name:
CALGARY
Provider Business Mailing Address State Name:
ALBERTA
Provider Business Mailing Address Postal Code:
T2M 3N3
Provider Business Mailing Address Country Code:
CA
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
SUITE 200
Provider Second Line Business Practice Location Address:
2004 14TH STREET NW
Provider Business Practice Location Address City Name:
CALGARY
Provider Business Practice Location Address State Name:
ALBERTA
Provider Business Practice Location Address Postal Code:
T2M 3N3
Provider Business Practice Location Address Country Code:
CA
Provider Business Practice Location Address Telephone Number:
403-282-6800
Provider Business Practice Location Address Fax Number:
403-282-6890
Provider Enumeration Date:
11/08/2021

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208200000X , with the licence number:  012917 , registered in the state of ZZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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