Provider Demographics
NPI:1558692574
Name:HARREL, NICHOLAS DAVID III (MD)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:DAVID
Last Name:HARREL
Suffix:III
Gender:M
Credentials:MD
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Mailing Address - Street 1:3815 E BELL RD
Mailing Address - Street 2:SUITE 2100
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-2122
Mailing Address - Country:US
Mailing Address - Phone:480-454-7350
Mailing Address - Fax:
Practice Address - Street 1:3815 E BELL RD
Practice Address - Street 2:STE 2100
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-2122
Practice Address - Country:US
Practice Address - Phone:480-454-7350
Practice Address - Fax:602-569-1038
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-15
Last Update Date:2016-05-02
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Provider Licenses
StateLicense IDTaxonomies
AZR70200208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ910778Medicaid
AZ910778Medicaid