Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | C39284 | CA |
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | C39284 | CA |
NPI | 1548226350 |
---|---|
Provider Name | Dr. Ferris Ray Nickel |
First Address | Ventura, CA 93003-7844 |
Second Address | Ventura, CA 93003-3165 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/04/2006 |
Last Update Date | 27/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A37105 | (02) | CA |
A37105 | UPIN (01) | CA |
C39284 | STATE LICENSE (01) | CA |