| Doctor Name: | ROBERT A. NICKELSON |
| NPI Number: | 1023019064 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | 015593 |
| Business Practice Address: | 2600 Kings Hwy Suite 340 Shreveport, LA - 71103 |
| Business Phone Number: | 3182128620 |
| Business Fax Number: | 3182128625 |
| Mailing Address: | 2600 Kings Hwy, Suite 340 SHREVEPORT |
| State: | LA |
| Postal Code: | 71103 |
| Phone Number: | 3182128620 |
| Fax Number: | 3182128625 |
| NPI Enumeration Date: | 08/01/2005 |
| NPI Last Update Date: | 12/18/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 207RH0003X |
| License Number: | 015593 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | LA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Internal Medicine |
| Taxonomy Specialization: | Hematology & Oncology |
| Taxonomy Definition: | An internist doctor of osteopathy that specializes in the treatment of the combination of hematology and oncology disorders. A doctor of osteopathy that is board eligible/certified by the American Osteopathic Board of Internal Medicine WAS able to obtain a Certificate of Special Qualifications in the field of Hematology and Oncology. The Certificate is NO longer offered. |