Provider Demographics
NPI:1437372406
Name:NICK NICHOLSON, M.D., P.A.
Entity Type:Organization
Organization Name:NICK NICHOLSON, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL SURGEON
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:NICHOLSON
Authorized Official - Suffix:IV
Authorized Official - Credentials:MD
Authorized Official - Phone:214-213-9120
Mailing Address - Street 1:5000 LEGACY DR STE 200
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-3373
Mailing Address - Country:US
Mailing Address - Phone:972-494-3100
Mailing Address - Fax:972-608-0005
Practice Address - Street 1:8080 INDEPENDENCE PKWY
Practice Address - Street 2:SUITE 115
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75025-4000
Practice Address - Country:US
Practice Address - Phone:972-494-3100
Practice Address - Fax:972-487-5646
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL1953208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00Z829Medicare PIN