MEDICARE: DR. DONALD GENE NICHOLAS JR. 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	207R00000X	Internal Medicine Physician	H1995	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	H1995	OTHER	TX	PHYSICIAN PERMIT

General Provider Information

NPI Number	:	1245226950
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DONALD GENE NICHOLAS JR. M.D.

Provider Business Mailing Address
First Line	:	PO BOX 2619
Second Line	:
City	:	DESOTO
State	:	TX
Zip	:	75123-2619
Country	:	US
Telephone Number	:	214-734-5380
Fax Number	:	972-224-9098

Provider Business Practice Location Address
First Line	:	1013 HICKORY BEND DR
Second Line	:
City	:	DESOTO
State	:	TX
Zip	:	75115-3846
Country	:	US
Telephone Number	:	972-224-9090
Fax Number	:

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

Provider Enumeration Date	:	09/27/2005
Last Update Date	:	03/20/2024

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