Provider Demographics
NPI:1659477610
Name:NICHOLS, CHRISTOPHER MEAD (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:MEAD
Last Name:NICHOLS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:6002 WESTGATE BLVD
Mailing Address - Street 2:SUITE 160
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98406-2570
Mailing Address - Country:US
Mailing Address - Phone:253-759-4522
Mailing Address - Fax:253-759-4699
Practice Address - Street 1:6002 WESTGATE BLVD
Practice Address - Street 2:SUITE 160
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98406-2570
Practice Address - Country:US
Practice Address - Phone:253-759-4522
Practice Address - Fax:253-759-4699
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2005026727208200000X
WAMD00049126208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0272224OtherSTATE L&I
WA8510752Medicaid
WAG8873979OtherMEDICARE
WAG8873979OtherMEDICARE