Individual
RICHARD D NICHOLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
515 E GARDEN ST, LAKELAND, FL 33805-4615
(863) 683-5454
(863) 683-4652
Mailing address
PO BOX 1725, LAKELAND, FL 33802-1725
(863) 683-5454
(863) 683-4652
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
ME88932
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
210792
AMERIGROUP
—
01
—
239523
WELLCARE
—
01
—
292845
AVMED
—
01
—
37724
BCBS
FL
01
—
4036259
AETNA
—
Enumeration date
09/12/2005
Last updated
10/30/2012
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