| Organization Name: | DONALD G NICHOLAS JR MD |
| NPI Number: | 1770516817 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DONALD GENE NICHOLAS (OWNER) |
| Mailing Address: | 2805 Prince George Ave Desoto |
| State: | TX US |
| Postal Code: | 751152047 |
| Phone Number: | 9722249090 |
| Fax Number: | 9722249098 |
| NPI Enumeration Date: | 07/09/2006 |
| NPI Last Update Date: | 01/26/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | H1995 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |