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NPI Code Detail

MEDICARE: STEPHEN FRANK NICHOLSON MD

MEDICARE: STEPHEN FRANK NICHOLSON 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
1207Q00000XFamily Medicine PhysicianMD13735OR

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 : 1336143932
Entity Type Code : Individual
Provider Name (Legal Business Name) : STEPHEN FRANK NICHOLSON MD
Provider Business Mailing Address
First Line : 36860 INDUSTRIAL WAY
Second Line :
City : SANDY
State : OR
Zip : 97055-7371
Country : US
Telephone Number : 503-826-0206
Fax Number : 503-826-0216
Provider Business Practice Location Address
First Line : 36860 INDUSTRIAL WAY
Second Line :
City : SANDY
State : OR
Zip : 97055-7371
Country : US
Telephone Number : 503-826-0206
Fax Number : 503-826-0216
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/10/2005
Last Update Date : 02/22/2011

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Directions to “ STEPHEN FRANK NICHOLSON MD” Practice Location

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