Provider Demographics
NPI:1619082294
Name:NICHOLS, RICHARD ALAN (PA DPM)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:ALAN
Last Name:NICHOLS
Suffix:
Gender:M
Credentials:PA DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 LANCASTER
Mailing Address - Street 2:SUITE 102
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051
Mailing Address - Country:US
Mailing Address - Phone:817-481-4000
Mailing Address - Fax:817-421-0732
Practice Address - Street 1:1600 LANCASTER DR
Practice Address - Street 2:SUITE 102
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-3579
Practice Address - Country:US
Practice Address - Phone:817-481-4000
Practice Address - Fax:817-421-0732
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX917213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00762KMedicare ID - Type Unspecified
T15038Medicare UPIN