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General NPI Number Information
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NPI Number | 1770516817
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Entity Type | Organization
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Legal Business Name | DONALD G NICHOLAS JR MD
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Dates
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Enumeration Date | 07/09/2006
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Last Update Date | 10/06/2017
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Provider Practice Location Address
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Address Line | 2701 PRINCE GEORGE AVE STE 100
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City | DESOTO
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State | TX
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Zip | 75115-2087
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Country | US
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Telephone | 972-224-9090
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Fax | 972-224-9098
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Provider Business Mailing Address
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Address Line | 2701 PRINCE GEORGE AVE, SUITE 100
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City | DESOTO
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State | TX
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Zip | 75115-2087
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Country | US
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Telephone | 972-224-9090
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Fax | 972-224-9098
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Authorized Official
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Title or Position | OWNER
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Name | DR. DONALD GENE NICHOLAS JR.
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Credential | M.D.
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Telephone | 972-224-9090
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | H1995
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License Number State | TX
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