Healthcare Provider Details

I. General information

NPI: 1700082260
Provider Name (Legal Business Name): MATTHEW CHARLES NICHOLS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2007
Last Update Date: 12/21/2021
Certification Date: 12/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7400 E OSBORN RD
SCOTTSDALE AZ
85251
US

IV. Provider business mailing address

PO BOX 2808
SCOTTSDALE AZ
85252-2808
US

V. Phone/Fax

Practice location:
  • Phone: 480-882-4809
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberP3397
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License NumberP3397
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number006552
License Number StateAZ
# 4
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number006552
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: