Provider Demographics
NPI:1669574893
Name:DAVID, NICCOS JOHN (DPM)
Entity type:Individual
Prefix:
First Name:NICCOS
Middle Name:JOHN
Last Name:DAVID
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:643 CAPE CORAL PKWY E
Mailing Address - Street 2:SUTIE D
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33904-8549
Mailing Address - Country:US
Mailing Address - Phone:239-542-3581
Mailing Address - Fax:239-542-4725
Practice Address - Street 1:643 CAPE CORAL PKWY E
Practice Address - Street 2:SUTIE D
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33904-8549
Practice Address - Country:US
Practice Address - Phone:239-542-3581
Practice Address - Fax:239-542-4725
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO3227213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist