Individual
WILLIAM JOHN NICHOLAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3202 MCINTOSH CIR, STE LL03, JOPLIN, MO 64804-3646
(417) 347-6400
Mailing address
PO BOX 3810, JOPLIN, MO 64803
(417) 347-6400
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
110180
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
060061613
RR MEDICARE
—
05
—
100137270C
—
KS
05
—
100137270D
—
KS
05
—
100202220A
—
OK
01
—
110817
KS BCBS
KS
01
—
117796
ANTHEM
MO
05
—
208167924
—
MO
01
—
424135
BCBS KS
KS
01
—
P00322601
RR MEDICARE
KS
Enumeration date
06/20/2006
Last updated
06/15/2015
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