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General NPI Number Information
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NPI Number | 1972575249
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Entity Type | Individual
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Provider Name | STEVEN LEE NICHOLS MD
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Gender | Male
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Dates
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Enumeration Date | 02/02/2006
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Last Update Date | 01/23/2014
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Provider Practice Location Address
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Address Line | 907 MOUNTAIN LION CIR
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City | HARKER HEIGHTS
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State | TX
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Zip | 76548-5713
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Country | US
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Telephone | 254-953-7700
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Fax | 254-953-7735
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Provider Business Mailing Address
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Address Line | PO BOX 847408
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City | DALLAS
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State | TX
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Zip | 75284-7408
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Country | US
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Telephone |
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Fax |
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | L0458
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License Number State | TX
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