| Doctor Name: | KARL R NICHOLES |
| NPI Number: | 1497912570 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | 146957-1205 |
| Business Practice Address: | 3655 S State St Salt Lake City, UT - 841154827 |
| Business Phone Number: | 8012933100 |
| Business Fax Number: | |
| Mailing Address: | 4267 Twin River Way, #1415 TAYLORSVILLE |
| State: | UT |
| Postal Code: | 841232829 |
| Phone Number: | 8015633104 |
| Fax Number: | |
| NPI Enumeration Date: | 05/17/2008 |
| NPI Last Update Date: | 05/17/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 146957-1205 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | UT |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |