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General NPI Number Information
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NPI Number | 1235303009
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Entity Type | Organization
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Legal Business Name | R C NICHOLS JR MD PA
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Dates
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Enumeration Date | 04/14/2008
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Last Update Date | 04/15/2008
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Provider Practice Location Address
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Address Line | 615 N BONITA AVE BAY REGIONAL CANCER CENTER
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City | PANAMA CITY
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State | FL
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Zip | 32401-3623
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Country | US
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Telephone | 850-747-6972
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Fax | 850-747-6584
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Provider Business Mailing Address
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Address Line | PO BOX 2506
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City | PANAMA CITY
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State | FL
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Zip | 32402-2506
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Country | US
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Telephone | 850-769-0009
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Fax | 850-769-0070
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | ROMAINE C NICHOLS
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Credential | M.D.
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Telephone | 850-769-0009
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QX0203X
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Taxonomy Name | Radiation Oncology Clinic/Center
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License Number | ME0056785
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License Number State | FL
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