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NPI Code Detail

MEDICARE: ANDREW J. NICKS MD

MEDICARE: ANDREW J. NICKS MD
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
12085R0202XDiagnostic Radiology PhysicianG24715CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1326014820
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANDREW J. NICKS MD
Provider Business Mailing Address
First Line : PO BOX 348120
Second Line :
City : SACRAMENTO
State : CA
Zip : 95834
Country : US
Telephone Number : 707-252-4633
Fax Number : 707-252-2240
Provider Business Practice Location Address
First Line : 1000 TRANCAS STREET
Second Line :
City : NAPA
State : CA
Zip : 94558-2906
Country : US
Telephone Number : 707-252-4411
Fax Number : 707-252-2240
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/24/2006
Last Update Date : 06/17/2008

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