Provider Demographics
NPI:1508941758
Name:NICHOLS, DAVID W (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:W
Last Name:NICHOLS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 733784
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-3784
Mailing Address - Country:US
Mailing Address - Phone:682-885-1855
Mailing Address - Fax:682-885-1396
Practice Address - Street 1:480 W SOUTHLAKE BLVD
Practice Address - Street 2:STE 133
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-6162
Practice Address - Country:US
Practice Address - Phone:817-329-9234
Practice Address - Fax:817-329-9239
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXJ6631208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
1750369203OtherGRP NPI NUMBER
TX974354OtherFIRSTHEALTH PIN
TX117558003Medicaid
TX5456412OtherAETNA PIN
TX1390384OtherUHC PIN
TX140442831Medicaid
TX140442861Medicaid
TX3232393OtherCIGNA PIN
TX86730SOtherBCBSTX IND PIN
TX00U87ZOtherBCBSTX GRP PIN
TXNICDG13441OtherCCHIP PIN
TXNICDG13441OtherCCHIP PIN
TX140442831Medicaid
TX00406KMedicare PIN