Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | ME44303 | FL |
N | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | ME0044303 | FL |
NPI | 1427050152 |
---|---|
Provider Name | Dr. George K Nichols |
First Address | Vero Beach, FL 32960-4862 |
Second Address | Vero Beach, FL 32960-5012 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/08/2005 |
Last Update Date | 15/08/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
042097200 | (05) | FL |
31160 | BC BS (01) | FL |
D54245 | (02) | FL |