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General NPI Number Information
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NPI Number | 1871997213
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Entity Type | Individual
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Provider Name | DAVID SCOTT NICKERSON MD
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Gender | Male
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Dates
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Enumeration Date | 10/14/2014
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Last Update Date | 10/14/2014
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Provider Practice Location Address
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Address Line | 56 CROWN DR
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City | BIG HORN
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State | WY
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Zip | 82833
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Country | US
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Telephone | 307-674-9875
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Fax | 307-678-7393
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Provider Business Mailing Address
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Address Line | 56 CROWN DRIVE
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City | BIG HORN
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State | WY
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Zip | 82833-0278
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 2688A
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License Number State | WY
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