Provider Demographics
NPI:1831151208
Name:NICKESON, DAVID CHRISTIAN SWOPE (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:CHRISTIAN SWOPE
Last Name:NICKESON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6807 EMMETT F LOWRY EXPRESSWAY
Mailing Address - Street 2:SUITE 303
Mailing Address - City:TEXAS CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77591-2543
Mailing Address - Country:US
Mailing Address - Phone:409-935-2995
Mailing Address - Fax:409-935-3433
Practice Address - Street 1:6807 EMMETT F LOWRY EXPRESSWAY
Practice Address - Street 2:SUITE 303
Practice Address - City:TEXAS CITY
Practice Address - State:TX
Practice Address - Zip Code:77591-2543
Practice Address - Country:US
Practice Address - Phone:409-935-2995
Practice Address - Fax:409-935-3433
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF3261207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX127944006Medicaid
TX8R3390OtherBLUE CROSS BLUE SHIELD
TX127944006Medicaid