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General NPI Number Information
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NPI Number | 1932370681
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Entity Type | Individual
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Provider Name | CAMERON LEE NICHOLSON M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/20/2008
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Last Update Date | 06/27/2024
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Provider Practice Location Address
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Address Line | 22655 BAYSHORE RD STE 110
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City | PORT CHARLOTTE
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State | FL
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Zip | 33980-2005
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Country | US
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Telephone | 941-235-4900
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Fax | 941-235-4901
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Provider Business Mailing Address
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Address Line | P.O. BOX 2147
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City | FT MYERS
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State | FL
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Zip | 33902-2147
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Country | US
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Telephone | 239-343-5553
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Fax | 239-343-5321
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | ME102793
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 57.006511
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License Number State | OH
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