Provider Demographics
NPI:1356388995
Name:NICHOLAS, GEORGE ALFRED (MD)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:ALFRED
Last Name:NICHOLAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:530 IOWA AVE SE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:HURON
Mailing Address - State:SD
Mailing Address - Zip Code:57350-2864
Mailing Address - Country:US
Mailing Address - Phone:605-352-7711
Mailing Address - Fax:605-352-7710
Practice Address - Street 1:530 IOWA AVE SE
Practice Address - Street 2:SUITE 106
Practice Address - City:HURON
Practice Address - State:SD
Practice Address - Zip Code:57350-2864
Practice Address - Country:US
Practice Address - Phone:605-352-7711
Practice Address - Fax:605-352-7710
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-01
Last Update Date:2010-02-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
SD2117207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDD25502Medicare UPIN
SD5603630Medicare ID - Type Unspecified
SDS6002Medicare ID - Type Unspecified