Individual
MR. CHONG H NICHOLLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
8075 N SHADELAND AVE STE 200, INDIANAPOLIS, IN 46250-2694
(317) 621-8500
Mailing address
PO BOX 2336, MOUNTAIN HOME, AR 72654-2336
(870) 424-7070
(870) 424-6616
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
01073755A
IN
207L00000X
Anesthesiology Physician
35.129284
OH
207L00000X
Anesthesiology Physician
37081
CO
207L00000X
Anesthesiology Physician
A80622
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01370816
—
CA
05
—
188700001
—
AR
05
—
201216590
—
IN
Enumeration date
05/20/2006
Last updated
06/05/2024
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