Individual
DR. DOUGLAS JOHN NICHOLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
315 W DALTON AVE STE B, COEUR D ALENE, ID 83815-8600
(208) 209-2066
(208) 262-2076
Mailing address
1593 E POLSTON AVE, POST FALLS, ID 83854-5326
(208) 262-2300
(208) 262-2390
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
O-310
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1538233796
—
ID
Enumeration date
11/20/2006
Last updated
05/02/2019
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