Provider Demographics
NPI:1487784815
Name:NICHOLL, RAYMOND PAUL (MD)
Entity type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:PAUL
Last Name:NICHOLL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2208 S NELLIS BLVD STE 5
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89104-6211
Mailing Address - Country:US
Mailing Address - Phone:702-798-7770
Mailing Address - Fax:702-895-7776
Practice Address - Street 1:2208 S NELLIS BLVD STE 5
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89104-6211
Practice Address - Country:US
Practice Address - Phone:702-798-7770
Practice Address - Fax:702-895-7776
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2025-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV4452207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVNV00471OtherEDI
NV1922273101Medicaid
NV002019494Medicaid
DT199YMedicare UPIN
NV1922273101Medicaid
NVV105992Medicare PIN