Provider Demographics
NPI:1891880282
Name:NICHOLS, JAMES M (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:M
Last Name:NICHOLS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3340 NORTH CENTER ST
Mailing Address - Street 2:#800
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-7406
Mailing Address - Country:US
Mailing Address - Phone:801-990-1911
Mailing Address - Fax:801-990-1912
Practice Address - Street 1:5121 S COTTONWOOD STREET
Practice Address - Street 2:INTERMOUNTAIN MEDICAL CENTER
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84157
Practice Address - Country:US
Practice Address - Phone:801-507-5248
Practice Address - Fax:801-733-5618
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2012-10-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
UT325356-1205207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100506344Medicaid
UT898749OtherDESERET MUTUAL
AZ941395Medicaid
UT1502954OtherUMWA
UTQM0000075886OtherALTIUS
WY121130700Medicaid
UT32535612000001OtherBCBS
ID807171800Medicaid
UT870545614JMNOtherEDUCATORS MUTUAL
UTTPRA11413OtherMOLINA
UT107037883101OtherIHC
UT2090168OtherUNITED HEALTHCARE
UT83769OtherPEHP
UT99468OtherHEALTHY U
UT870545614JMNOtherEDUCATORS MUTUAL
WY121130700Medicaid