Provider Demographics
NPI:1124417373
Name:NICHOLSON, ROBERT J JR (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:J
Last Name:NICHOLSON
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:42078 VETERANS AVENUE
Mailing Address - Street 2:SUITE G
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70403
Mailing Address - Country:US
Mailing Address - Phone:985-542-7177
Mailing Address - Fax:985-340-7078
Practice Address - Street 1:42078 VETERANS AVENUE
Practice Address - Street 2:SUITE G
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403
Practice Address - Country:US
Practice Address - Phone:985-542-7177
Practice Address - Fax:985-340-7078
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-12
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA016664174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist