Provider Demographics
NPI:1598467185
Name:METHENY, NICHOLAS JAMES (DO)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:JAMES
Last Name:METHENY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:YOKOSUKA, HONCHO 2-1-19 RM#601 BLDG#2
Mailing Address - Street 2:
Mailing Address - City:YOKOSUKA
Mailing Address - State:KANAGAWA
Mailing Address - Zip Code:2380041
Mailing Address - Country:JP
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:PSC 473 BOX 47 FPO AP
Practice Address - Street 2:
Practice Address - City:YOKOSUKA
Practice Address - State:KANAGAWA
Practice Address - Zip Code:96349
Practice Address - Country:JP
Practice Address - Phone:315-241-8016
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-20
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FL21353171000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171000000XOther Service ProvidersMilitary Health Care Provider
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program