Provider Demographics
NPI:1669707212
Name:NICHOLS, CARL THOMAS (MD)
Entity type:Individual
Prefix:DR
First Name:CARL
Middle Name:THOMAS
Last Name:NICHOLS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 S HAYDEN ST
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79109-2206
Mailing Address - Country:US
Mailing Address - Phone:806-433-9345
Mailing Address - Fax:806-345-7450
Practice Address - Street 1:2200 S HAYDEN ST
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79109-2206
Practice Address - Country:US
Practice Address - Phone:806-433-9345
Practice Address - Fax:806-345-7450
Is Sole Proprietor?:No
Enumeration Date:2009-10-14
Last Update Date:2009-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD4536207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXC19891Medicare UPIN