Provider Demographics
NPI:1699928077
Name:STRANGE, NICHOLAS GEOFFREY (DO)
Entity type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:GEOFFREY
Last Name:STRANGE
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 1:905 E WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94952-3389
Mailing Address - Country:US
Mailing Address - Phone:707-763-9891
Mailing Address - Fax:707-762-2311
Practice Address - Street 1:905 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94952-3389
Practice Address - Country:US
Practice Address - Phone:707-763-9891
Practice Address - Fax:707-762-2311
Is Sole Proprietor?:No
Enumeration Date:2008-10-29
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA20A12113207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFX634ZMedicare PIN