Individual
LARRY W NICHOLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
590 S MAIN ST, SNOWFLAKE, AZ 85937
(928) 536-7519
(928) 536-7305
Mailing address
590 S MAIN ST, SNOWFLAKE, AZ 85937
(928) 536-7519
(928) 536-7305
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
14326
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
250308
—
AZ
Enumeration date
02/01/2006
Last updated
03/06/2014
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