| Doctor Name: | TIMOTHY D NICHOLS |
| NPI Number: | 1093752073 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MD |
| License Number: | J1744 |
| Business Practice Address: | 12606 Greenville Ave Suite 160 Dallas, TX - 752431921 |
| Business Phone Number: | 4693647880 |
| Business Fax Number: | 4693647895 |
| Mailing Address: | Po Box 797885, DALLAS |
| State: | TX |
| Postal Code: | 753797885 |
| Phone Number: | 9406260059 |
| Fax Number: | 9406272289 |
| NPI Enumeration Date: | 05/31/2006 |
| NPI Last Update Date: | 08/20/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 174400000X |
| License Number: | J1744 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Specialist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |