Provider Demographics
NPI:1891776209
Name:NICHOLS, ROBERT R (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:R
Last Name:NICHOLS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:403 WOODLAND HILLS BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT SCOTT
Mailing Address - State:KS
Mailing Address - Zip Code:66701-8798
Mailing Address - Country:US
Mailing Address - Phone:620-223-8040
Mailing Address - Fax:620-223-8002
Practice Address - Street 1:403 WOODLAND HILLS BLVD
Practice Address - Street 2:
Practice Address - City:FORT SCOTT
Practice Address - State:KS
Practice Address - Zip Code:66701-8798
Practice Address - Country:US
Practice Address - Phone:620-223-8040
Practice Address - Fax:620-223-8524
Is Sole Proprietor?:No
Enumeration Date:2005-11-11
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS0417312207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100165410BMedicaid
KS100165410BMedicaid
KS40369Medicare PIN