Provider Demographics
NPI:1205832326
Name:NICHOLSON, WILLIAM DANIEL III (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:DANIEL
Last Name:NICHOLSON
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:DAN
Other - Middle Name:
Other - Last Name:NICHOLSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:5425 W SPRING CREEK PKWY
Mailing Address - Street 2:STE 140
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-4236
Mailing Address - Country:US
Mailing Address - Phone:972-494-3100
Mailing Address - Fax:972-487-5646
Practice Address - Street 1:700 WALTER REED BLVD
Practice Address - Street 2:STE 301
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75042-3716
Practice Address - Country:US
Practice Address - Phone:972-494-3100
Practice Address - Fax:972-494-1200
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-23
Last Update Date:2009-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD8367208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX034811201Medicaid
TX034811201Medicaid
TX00M500Medicare ID - Type Unspecified