Healthcare Provider Details

I. General information

NPI: 1861604175
Provider Name (Legal Business Name): DAVID PAUL NICHOLS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 01/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4800 SAND POINT WAY NE
SEATTLE WA
98105-3901
US

IV. Provider business mailing address

1959 NE PACIFIC STREET BOX 356320
SEATTLE WA
98195-0001
US

V. Phone/Fax

Practice location:
  • Phone: 206-987-1494
  • Fax:
Mailing address:
  • Phone: 206-987-1494
  • Fax: 206-987-7505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License NumberMD60644594
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: