Provider Demographics
NPI:1770720377
Name:NICHOLS, DAVID C
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:C
Last Name:NICHOLS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:606 E GOODE ST
Mailing Address - Street 2:SUITE # 400
Mailing Address - City:QUITMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75783-2567
Mailing Address - Country:US
Mailing Address - Phone:903-763-4709
Mailing Address - Fax:903-376-3470
Practice Address - Street 1:606 E GOODE ST
Practice Address - Street 2:SUITE # 400
Practice Address - City:QUITMAN
Practice Address - State:TX
Practice Address - Zip Code:75783-2567
Practice Address - Country:US
Practice Address - Phone:903-763-4709
Practice Address - Fax:903-763-4709
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-19
Last Update Date:2009-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM4580207QS1201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QS1201XAllopathic & Osteopathic PhysiciansFamily MedicineSleep MedicineGroup - Multi-Specialty