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Individual

DANE J NICHOLS

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
3181 SW SAM JACKSON PARK RD, PORTLAND, OR 97239-3011
(503) 494-1620
Mailing address
7849 SW GALE RIDGE LN, PORTLAND, OR 97229

Taxonomy

Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
Primary
MD21683
OR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
134902
OR
Enumeration date
09/20/2006
Last updated
07/08/2007
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