Individual
DR. JAMES THOMAS NICHOLS III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3635 PENNSYLVANIA AVE, MIMS, FL 32754-5114
(321) 289-2204
(405) 844-1794
Mailing address
3635 PENNSYLVANIA AVE, MIMS, FL 32754-5114
(321) 289-2204
(405) 844-1794
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
ME122364
FL
208D00000X
General Practice Physician
Primary
ME122364
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1010693
—
LA
01
—
P01045513
RAILROAD MCARE
LA
Enumeration date
06/22/2007
Last updated
11/18/2015
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