Provider Demographics
NPI:1902207699
Name:NICKEL, SCOTT CHRISTOPHER (MD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:CHRISTOPHER
Last Name:NICKEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:514 W PUEBLO ST FL 2
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93105-6219
Mailing Address - Country:US
Mailing Address - Phone:805-682-7751
Mailing Address - Fax:
Practice Address - Street 1:514 W PUEBLO ST FL 2
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93105-6219
Practice Address - Country:US
Practice Address - Phone:805-682-7751
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-12
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAA151589207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program