Provider Demographics
NPI:1235164898
Name:NOMICOS, NICHOLAS EUGENE (MD)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:EUGENE
Last Name:NOMICOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:14425 SPYGLASS CIR
Mailing Address - Street 2:
Mailing Address - City:CHOWCHILLA
Mailing Address - State:CA
Mailing Address - Zip Code:93610-7907
Mailing Address - Country:US
Mailing Address - Phone:559-363-0708
Mailing Address - Fax:888-376-2184
Practice Address - Street 1:101 N FRONT ST STE B
Practice Address - Street 2:
Practice Address - City:CHOWCHILLA
Practice Address - State:CA
Practice Address - Zip Code:93610
Practice Address - Country:US
Practice Address - Phone:559-201-9181
Practice Address - Fax:559-201-9395
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2018-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA49055208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF22186Medicare UPIN