MEDICARE: DAVID CHRISTIAN SWOPE NICKESON 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	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	F3261	TX
2	207RP1001X	Pulmonary Disease Physician	F3261	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	8R3390	OTHER	TX	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1831151208
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID CHRISTIAN SWOPE NICKESON MD

Provider Business Mailing Address
First Line	:	6807 EMMETT F LOWRY EXPRESSWAY
Second Line	:	SUITE 303
City	:	TEXAS CITY
State	:	TX
Zip	:	77591-2543
Country	:	US
Telephone Number	:	409-935-2995
Fax Number	:	409-935-3433

Provider Business Practice Location Address
First Line	:	6807 EMMETT F LOWRY EXPRESSWAY
Second Line	:	SUITE 303
City	:	TEXAS CITY
State	:	TX
Zip	:	77591-2543
Country	:	US
Telephone Number	:	409-935-2995
Fax Number	:	409-935-3433

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

Provider Enumeration Date	:	04/03/2006
Last Update Date	:	08/25/2020

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