Healthcare Provider Details

I. General information

NPI: 1003951245
Provider Name (Legal Business Name): DAVID NICHOLS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 10/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2018 PULLIAM ST
SAN ANGELO TX
76905
US

IV. Provider business mailing address

730 EAST EUREKA STREET
WEATHERFORD TX
76086-6546
US

V. Phone/Fax

Practice location:
  • Phone: 325-659-7290
  • Fax: 325-659-7291
Mailing address:
  • Phone: 817-596-7000
  • Fax: 817-596-7008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0005X
TaxonomyUndersea and Hyperbaric Medicine (Emergency Medicine) Physician
License NumberN0321
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberN0321
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: