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General NPI Number Information
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NPI Number | 1427311869
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Entity Type | Organization
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Legal Business Name | GARY W NICKEL, MD
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Dates
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Enumeration Date | 06/20/2012
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Last Update Date | 06/20/2012
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Provider Practice Location Address
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Address Line | 222 N J ST SUITE A
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City | TACOMA
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State | WA
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Zip | 98403-1984
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Country | US
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Telephone | 253-572-4664
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Fax | 253-591-0097
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Provider Business Mailing Address
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Address Line | 222 N J ST SUITE A
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City | TACOMA
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State | WA
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Zip | 98403-1984
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Country | US
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Telephone | 253-572-4664
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Fax | 253-591-0097
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. GARY WAYNE NICKEL
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Credential | MD
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Telephone | 253-572-4664
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State |
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