Healthcare Provider Details

I. General information

NPI: 1942839600
Provider Name (Legal Business Name): NICHOLAS REID DESLAURIERS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: NICHOLAS REID DESLAURIERS

II. Dates (important events)

Enumeration Date: 04/05/2020
Last Update Date: 04/08/2026
Certification Date: 04/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

513 PARNASSUS AVE # 380
SAN FRANCISCO CA
94143-2205
US

IV. Provider business mailing address

PO BOX 50095
SEATTLE WA
98145-5095
US

V. Phone/Fax

Practice location:
  • Phone: 415-476-9363
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD61319231
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA196214
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberMD61319231
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: