Individual
DOUGLAS A NUCKOLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
10021 DUPONT CIRCLE CT, FORT WAYNE, IN 46825-1604
(260) 426-8117
(260) 420-0817
Mailing address
10021 DUPONT CIRCLE CT, FORT WAYNE, IN 46825-1604
(260) 426-8117
(260) 420-0817
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
01052220A
IN
207Y00000X
Otolaryngology Physician
35-07-8501
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200262190
—
IN
05
—
2207543
—
OH
Enumeration date
08/17/2005
Last updated
11/20/2009
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