Organization
GORGE BONE DENSITY TESTING LLC
Active
Other names
THOMAS A NICHOL
Organization subpart
No
Provider details
NPI number
Authorized official
THOMAS J NICHOL MD (OPERATING MANAGER)
(509) 493-1467
Entity
Organization
Contact information
Practice address
1825 E 19TH ST, SUITE 3, THE DALLES, OR 97058-3365
(509) 493-1467
(509) 493-3765
Mailing address
1825 E 19TH ST, SUITE 3, THE DALLES, OR 97058-3365
(509) 493-1467
(509) 493-3765
Taxonomy
Speciality
Code
Description
License number
State
207RI0200X
Infectious Disease Physician
Primary
MD16255
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002415
—
OR
01
—
1059047
WASHINGTON MEDICAID
WA
01
—
K285401
PACIFIC SOURCE
OR
Enumeration date
01/08/2007
Last updated
09/05/2007
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