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General NPI Number Information
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NPI Number | 1770706400
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Entity Type | Organization
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Legal Business Name | THOMAS D NICHOLAS MD DANIEL J DWYER MD
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Dates
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Enumeration Date | 04/11/2007
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Last Update Date | 07/24/2008
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Provider Practice Location Address
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Address Line | 111 W HIGH ST
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City | ROCKVILLE
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State | IN
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Zip | 47872
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Country | US
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Telephone | 765-569-2057
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Fax | 765-569-2340
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Provider Business Mailing Address
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Address Line | 111 W HIGH ST
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City | ROCKVILLE
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State | IN
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Zip | 47872
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Country | US
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Telephone | 765-569-2057
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Fax | 765-569-2340
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Authorized Official
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Title or Position | PARTNER
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Name | DANIEL J DWYER
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Credential | MD
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Telephone | 765-569-2057
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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 | 15D0362127
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License Number State |
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