Individual
RUSSEL JAMES NICHOLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
130 THOMPSON AVENUE, HEPPNER, OR 97836
(541) 676-5504
(541) 676-8247
Mailing address
PO BOX 9, 564 E PIONEER DR, HEPPNER, OR 97836
(541) 676-5504
(541) 676-8247
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
MD22062
OR
207Q00000X
Family Medicine Physician
MD00039026
WA
207Q00000X
Family Medicine Physician
MD22062
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
106707
MEDICARE PTAN
OR
05
—
287633
—
OR
Enumeration date
07/07/2005
Last updated
03/06/2024
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