Provider Demographics
NPI:1285639898
Name:PRICE, NICHOLAS W (MD FACS)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:W
Last Name:PRICE
Suffix:
Gender:M
Credentials:MD FACS
Other - Prefix:
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Mailing Address - Street 1:603 7TH ST SO
Mailing Address - Street 2:#500
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-4734
Mailing Address - Country:US
Mailing Address - Phone:727-822-0442
Mailing Address - Fax:727-821-0416
Practice Address - Street 1:603-7TH ST SO
Practice Address - Street 2:#500
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-4734
Practice Address - Country:US
Practice Address - Phone:727-822-0442
Practice Address - Fax:727-821-0416
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2016-09-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME40957208600000X, 207P00000X, 2086S0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL040471300Medicaid
FLD54072Medicare UPIN
FL040471300Medicaid