Organization
RUSSEL NICHOLS, MD, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RUSSEL JAMES NICHOLS MD (OWNER)
(541) 575-2669
Entity
Organization
Contact information
Practice address
135 FORD RD, JOHN DAY, OR 97845-2010
(541) 575-2669
(541) 575-2743
Mailing address
135 FORD RD, JOHN DAY, OR 97845-2010
(541) 575-2669
(541) 575-2743
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD22062
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
287633
—
OR
01
—
4532990001
NSC/DME
—
01
—
MD00039026
WA LICENSE NUMBER
WA
Enumeration date
07/08/2005
Last updated
08/22/2020
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