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General NPI Number Information
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NPI Number | 1245226950
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Entity Type | Individual
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Provider Name | DONALD GENE NICHOLAS JR. M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/27/2005
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Last Update Date | 03/20/2024
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Provider Practice Location Address
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Address Line | 1013 HICKORY BEND DR
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City | DESOTO
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State | TX
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Zip | 75115-3846
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Country | US
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Telephone | 972-224-9090
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2619
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City | DESOTO
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State | TX
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Zip | 75123-2619
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Country | US
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Telephone | 214-734-5380
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Fax | 972-224-9098
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | H1995
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License Number State | TX
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