Provider Demographics
NPI:1114924966
Name:NICHOL, JAMES WILLIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:WILLIAM
Last Name:NICHOL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JIM
Other - Middle Name:WILLIAM
Other - Last Name:NICHOL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1350 EAST MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945
Mailing Address - Country:US
Mailing Address - Phone:530-477-8545
Mailing Address - Fax:530-477-7177
Practice Address - Street 1:1350 EAST MAIN ST
Practice Address - Street 2:
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945
Practice Address - Country:US
Practice Address - Phone:530-477-8545
Practice Address - Fax:530-477-7177
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2013-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO40830173000000X
HI13474207Q00000X
CAA101845207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI550724-01Medicaid
CO69982384Medicaid
HI12-1824Medicare ID - Type Unspecified
125807Medicare UPIN
HI550724-01Medicaid
HI125807Medicare UPIN