Provider Demographics
NPI:1992776603
Name:NICHOLS, JOSEPH CARROL JR (MD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:CARROL
Last Name:NICHOLS
Suffix:JR
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 1:1056 6TH AVE S
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98020-4035
Mailing Address - Country:US
Mailing Address - Phone:425-452-0632
Mailing Address - Fax:
Practice Address - Street 1:1056 6TH AVE S
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98020-4035
Practice Address - Country:US
Practice Address - Phone:425-452-0632
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00017712207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery