Nicolaisen, Gary S.

Nicolaisen, Gary S. is an individual health care provider with primary practice located at 99 Montecillo Rd , San Rafael CA 94903-3308. He recently has only one registered license in Allopathic & Osteopathic Physicians / Urology, which is considered as his primary health care specialty. Nicolaisen, Gary S. can be contacted via phone (415) 444-2000.

Contact Information

Primary practice address
99 Montecillo Rd San Rafael CA 94903-3308
Phone: (415) 444-2000
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Urology 208800000X G42970 California

Profile Details

NPI number 1598849572
LBN Legal business name Nicolaisen, Gary S.
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 25th, 2006
Last updated Jul 8th, 2007 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1598849572 NPPES
California MEDICAID 00G429700

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