# R C NICHOLS JR MD PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1235303009
- **Authorized official:** ROMAINE C NICHOLS M.D. (MEDICAL DIRECTOR)
- **Authorized official phone:** (850) 769-0009

## Contact information

- **Practice address:** 615 N BONITA AVE, BAY REGIONAL CANCER CENTER, PANAMA CITY, FL 32401-3623
- **Practice address phone:** (850) 747-6972
- **Practice address fax:** (850) 747-6584
- **Mailing address:** PO BOX 2506, PANAMA CITY, FL 32402-2506
- **Mailing address phone:** (850) 769-0009
- **Mailing address fax:** (850) 769-0070

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QX0203X | Radiation Oncology Clinic/Center | ME0056785 | FL | Yes |

## Other

- **Enumeration date:** 04/14/2008
- **Last updated:** 04/15/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 15097 | BLUE CROSS OF FLORIDA | FL |