MEDICARE: DR. WILLIAM DANIEL NICHOLSON III M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	D8367	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205832326
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM DANIEL NICHOLSON III M.D.

Provider Business Mailing Address
First Line	:	5425 W SPRING CREEK PKWY
Second Line	:	STE 140
City	:	PLANO
State	:	TX
Zip	:	75024-4236
Country	:	US
Telephone Number	:	972-494-3100
Fax Number	:	972-487-5646

Provider Business Practice Location Address
First Line	:	700 WALTER REED BLVD
Second Line	:	STE 301
City	:	GARLAND
State	:	TX
Zip	:	75042-3716
Country	:	US
Telephone Number	:	972-494-3100
Fax Number	:	972-494-1200

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/23/2005
Last Update Date	:	04/20/2009

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