Provider Demographics
NPI:1548226350
Name:NICKEL, FERRIS RAY (MD)
Entity Type:Individual
Prefix:DR
First Name:FERRIS
Middle Name:RAY
Last Name:NICKEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:F.
Other - Middle Name:RAY
Other - Last Name:NICKEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:5720 RALSTON ST STE 200
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-7844
Mailing Address - Country:US
Mailing Address - Phone:805-804-4168
Mailing Address - Fax:805-830-1177
Practice Address - Street 1:3525 LOMA VISTA RD STE A
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-3165
Practice Address - Country:US
Practice Address - Phone:805-641-6415
Practice Address - Fax:805-641-6424
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2022-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC39284207XX0004X, 207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC39284OtherSTATE LICENSE
CAA37105OtherUPIN
CAWC39284CMedicare PIN
CAW268AMedicare PIN
CAW268Medicare PIN