MEDICARE: DR. BRIAN THOMAS NICHOL M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207LP2900X	Pain Medicine (Anesthesiology) Physician	E-0476	AR

General Provider Information

NPI Number	:	1134252299
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRIAN THOMAS NICHOL M.D.

Provider Business Mailing Address
First Line	:	5106 MCCLANAHAN DR
Second Line	:	SUITE B
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72116-7051
Country	:	US
Telephone Number	:	501-255-6673
Fax Number	:	501-255-1509

Provider Business Practice Location Address
First Line	:	5106 MCCLANAHAN DR
Second Line	:	SUITE B
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72116-7051
Country	:	US
Telephone Number	:	501-255-6673
Fax Number	:	501-255-1509

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/14/2007
Last Update Date	:	07/08/2007

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