Basic Information
| Provider Information | |||||||||
| NPI: | 1902893993 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NICHOLS | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | ALAN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 284 N HOSPITAL DR | ||||||||
| Address2: | STE 2 | ||||||||
| City: | PRICE | ||||||||
| State: | UT | ||||||||
| PostalCode: | 845014235 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4356131450 | ||||||||
| FaxNumber: | 4356131451 | ||||||||
| Practice Location | |||||||||
| Address1: | 1034 N 500 W STE 101 | ||||||||
| Address2: | |||||||||
| City: | PROVO | ||||||||
| State: | UT | ||||||||
| PostalCode: | 846043380 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8013578310 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/04/2005 | ||||||||
| LastUpdateDate: | 08/10/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/10/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 1847671205 | UT | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.