Individual
ROBERT A. NICKELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2600 KINGS HWY, SUITE 340, SHREVEPORT, LA 71103
(318) 212-8620
(318) 212-8625
Mailing address
2600 KINGS HWY, SUITE 340, SHREVEPORT, LA 71103
(318) 212-8620
(318) 212-8625
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
Primary
015593
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1322741
—
LA
Enumeration date
08/01/2005
Last updated
12/18/2007
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