| Russel Nichols, Md, Pc | |
|
135 Ford Rd John Day OR 97845-2010 | |
| (541) 575-2669 | |
| (541) 575-2743 |
| Full Name | Russel Nichols, Md, Pc |
|---|---|
| Speciality | Family Medicine |
| Location | 135 Ford Rd, John Day, Oregon |
| Authorized Official Name and Position | Russel James Nichols (OWNER) |
| Authorized Official Contact | 5415752669 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Russel Nichols, Md, Pc 135 Ford Rd John Day OR 97845-2010 Ph: (541) 575-2669 | Russel Nichols, Md, Pc 135 Ford Rd John Day OR 97845-2010 Ph: (541) 575-2669 |
| NPI Number | 1609874247 |
|---|---|
| Provider Enumeration Date | 07/08/2005 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609874247 | NPI | - | NPPES |
| MD00039026 | Other | WA | WA LICENSE NUMBER |
| 4532990001 | Other | NSC/DME | |
| 287633 | Medicaid | OR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | MD22062 (Oregon) | Primary |
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