Individual
ROBERT LEE NICHOLAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1850 N CENTRAL AVE, STE 1600, PHOENIX, AZ 85004-4633
(602) 744-4765
(602) 744-4799
Mailing address
1850 N CENTRAL AVE, STE 1600, PHOENIX, AZ 85004-4633
(602) 744-4765
(602) 744-4799
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
23371
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
315136
—
AZ
01
—
P00046099
MEDICARE RAILROAD
—
Enumeration date
03/02/2006
Last updated
10/27/2010
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