Provider Demographics
NPI:1821188483
Name:BIRLEW, NICHOLAS RAYMOND (DO)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:RAYMOND
Last Name:BIRLEW
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1148 W HAMMER LN
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95209-3011
Mailing Address - Country:US
Mailing Address - Phone:209-952-9696
Mailing Address - Fax:209-952-3414
Practice Address - Street 1:1148 W HAMMER LN
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95209-3011
Practice Address - Country:US
Practice Address - Phone:209-952-9696
Practice Address - Fax:209-952-3414
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA20A4979207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine