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NPI Code Detail

MEDICARE: DR. ROGER D NICHOLS M.D.

MEDICARE: DR. ROGER D NICHOLS 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
12085R0202XDiagnostic Radiology Physician35993CO
22085R0204XVascular & Interventional Radiology Physician35993CO

General Provider Information

NPI Number : 1336114891
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ROGER D NICHOLS M.D.
Provider Business Mailing Address
First Line : 42 GARDEN CTR
Second Line :
City : BROOMFIELD
State : CO
Zip : 80020-1730
Country : US
Telephone Number : 303-465-0401
Fax Number :
Provider Business Practice Location Address
First Line : 4747 ARAPAHOE AVE
Second Line :
City : BOULDER
State : CO
Zip : 80303-1131
Country : US
Telephone Number : 303-415-7000
Fax Number : 303-438-1351
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/20/2006
Last Update Date : 05/13/2025

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