Individual
TIMOTHY D NICHOLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
12606 GREENVILLE AVE, SUITE 160, DALLAS, TX 75243-1921
(469) 364-7880
(469) 364-7895
Mailing address
PO BOX 797885, DALLAS, TX 75379-7885
(940) 626-0059
(940) 627-2289
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
J1744
TX
2085R0001X
Radiation Oncology Physician
Primary
J1744
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
126533203
—
TX
01
—
920003991
RAILROAD MEDICARE
TX
Enumeration date
05/31/2006
Last updated
03/23/2021
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