Provider Demographics
NPI:1427050152
Name:NICHOLS, GEORGE K (MD)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:K
Last Name:NICHOLS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 36TH ST
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-4862
Mailing Address - Country:US
Mailing Address - Phone:772-794-5611
Mailing Address - Fax:772-794-1450
Practice Address - Street 1:3450 11TH CT
Practice Address - Street 2:SUITE 302A
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-5012
Practice Address - Country:US
Practice Address - Phone:772-794-1444
Practice Address - Fax:772-794-1475
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0044303207XS0114X
FLME44303207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL31160OtherBC BS
FL042097200Medicaid
FL042097200Medicaid
FLD54245Medicare UPIN
FL31160ZMedicare PIN