Provider Demographics
NPI:1427311869
Name:GARY W NICKEL, MD
Entity type:Organization
Organization Name:GARY W NICKEL, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:NICKEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:253-572-4664
Mailing Address - Street 1:222 N J ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98403-1984
Mailing Address - Country:US
Mailing Address - Phone:253-572-4664
Mailing Address - Fax:253-591-0097
Practice Address - Street 1:222 N J ST
Practice Address - Street 2:SUITE A
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98403-1984
Practice Address - Country:US
Practice Address - Phone:253-572-4664
Practice Address - Fax:253-591-0097
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-20
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty