Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | G35186 | CA |
NPI | 1114005246 |
---|---|
Provider Name | John Geren Nichols |
First Address | Oakland, CA 94612-3429 |
Second Address | Fresno, CA 93720-2941 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G351860 | (05) | CA |
A46248 | (02) |