Larry W Nichols, MD
Individual provider Active NPI Family Medicine Physician · Snowflake, AZ
NPI 1225009608 · NPPES record last updated Mar 6, 2014
Key facts
- NPI
- 1225009608
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 14326 (AZ)
- Practice address
- 590 S Main St
Snowflake, AZ 85937 - Phone
- (928) 536-7519
- Fax
- (928) 536-7305
- NPI assigned
- Feb 1, 2006
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 14326 | AZ | MD | Family Medicine Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 14326 | AZ | Yes |
Addresses
Primary practice location
590 S Main St
Snowflake, AZ 85937
Mailing address
590 S Main St
Snowflake, AZ 85937
Phone (928) 536-7519
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 250308 | Medicaid | AZ |
Other providers in Snowflake, AZ
- Natural Choice Family Wellness, LLC
- Nauthiz Industries
- Navajo Mobility Solutions LLC
- Neuropathy Center of the White Mountains
- Douglas Ryan Nichols
- Lynette Kay Nicoll
- Starr Penrod Ollerton
- James Randall Olson
- Bobbye Jaelene Ortiz
- Fredrick Bruce Packard
All providers in Snowflake, AZ · Family Medicine Physician in Arizona
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 6, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.