MEDICARE: DR. GEORGE K NICHOLS 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
1	207XS0114X	Adult Reconstructive Orthopaedic Surgery Physician	ME0044303	FL
2	207X00000X	Orthopaedic Surgery Physician	ME44303	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	31160	OTHER	FL	BC BS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1427050152
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GEORGE K NICHOLS MD

Provider Business Mailing Address
First Line	:	1000 36TH ST
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32960-4862
Country	:	US
Telephone Number	:	772-794-5611
Fax Number	:	772-794-1450

Provider Business Practice Location Address
First Line	:	3450 11TH CT
Second Line	:	SUITE 302A
City	:	VERO BEACH
State	:	FL
Zip	:	32960-5012
Country	:	US
Telephone Number	:	772-794-1444
Fax Number	:	772-794-1475

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

Provider Enumeration Date	:	08/12/2005
Last Update Date	:	07/21/2022

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