Individual
MARK DAVID NICOLAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3800 S NATIONAL AVE STE 600, SPRINGFIELD, MO 65807-5249
(417) 875-3000
Mailing address
PO BOX 802843, KANSAS CITY, MO 64180-2843
Taxonomy
Speciality
Code
Description
License number
State
2086S0127X
Trauma Surgery Physician
Primary
2021027694
MO
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200100628
—
MO
Enumeration date
03/30/2015
Last updated
09/23/2021
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