Provider Demographics
NPI:1356328033
Name:NICHOLS, DONALD LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:LEE
Last Name:NICHOLS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2450 STANLEY ROAD
Mailing Address - Street 2:SUITE 208
Mailing Address - City:FORT SAM HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:78234-6102
Mailing Address - Country:US
Mailing Address - Phone:210-295-1271
Mailing Address - Fax:210-295-2789
Practice Address - Street 1:3851 ROGER BROOKE DR
Practice Address - Street 2:MCHE-QD (CREDS)
Practice Address - City:FORT SAM HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:78234-6200
Practice Address - Country:US
Practice Address - Phone:210-916-1030
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-23
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ARC-7632207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine