Scott C Wickless (NPI# 1043222714, PAC ID# 0648275388) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is DERMATOLOGY.
| Nation Provider ID (NPI) | 1043222714 |
| PAC ID by PECOS | 0648275388 |
| Professional Enrollment ID | I20090915000442 |
| Full Name | Scott C Wickless |
| Organization Legal Name | DURANGO DERMATOLOGY AND DERMATOLOGIC SURGERY LLC |
| Address |
523 S Camino Del Rio Suite B Durango CO 81303-6853 |
| Phone Number | 9702471970 |
| Gender | M |
| Credential | DO |
| Medical School | KIRKSVILLE COLLEGE OF OSTEOPATHIC MEDICINE |
| Graduation Year | 2002 |
| Primary Specialty | DERMATOLOGY |
| Secondary Specialties | PATHOLOGY |
| Group Practice PAC ID | 1153375902 |
| Number of Group Practice Members | 6 |
| Accepts Medicare Assignment | Y |
| Address | Phone | Organization |
|---|---|---|
| 523 S Camino Del Rio, Suite B, Durango, CO 81303-6853 | 9702471970 | DURANGO DERMATOLOGY AND DERMATOLOGIC SURGERY LLC |
| Organization Legal Name | DURANGO DERMATOLOGY AND DERMATOLOGIC SURGERY LLC |
| Physicians | 6 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Haley G Frazier | Physician Assistant | Durango Dermatology and Dermatologic Surgery LLC | 523 S Camino Del Rio, Suite B, Durango, CO 81303-6853 |
| Jay Nichols Joy | Pathology | Durango Dermatology and Dermatologic Surgery LLC | 523 S Camino Del Rio, Suite B, Durango, CO 81303-6853 |
| Michelle Lynn Goedken | Dermatology | Durango Dermatology and Dermatologic Surgery LLC | 523 S Camino Del Rio, Suite B, Durango, CO 81303-6853 |
| Mark D Gaughan | Dermatology | Durango Dermatology and Dermatologic Surgery LLC | 523 S Camino Del Rio, Suite B, Durango, CO 81303-6853 |
| Kristin E Pogue | Physician Assistant | Durango Dermatology and Dermatologic Surgery LLC | 523 S Camino Del Rio, Suite B, Durango, CO 81303-6853 |
| Street Address |
523 S CAMINO DEL RIO SUITE B |
| City | DURANGO |
| State | CO |
| Zip | 81303-6853 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Haley G Frazier | Physician Assistant | Durango Dermatology and Dermatologic Surgery LLC | 523 S Camino Del Rio, Suite B, Durango, CO 81303-6853 |
| Jay Nichols Joy | Pathology | Durango Dermatology and Dermatologic Surgery LLC | 523 S Camino Del Rio, Suite B, Durango, CO 81303-6853 |
| Michelle Lynn Goedken | Dermatology | Durango Dermatology and Dermatologic Surgery LLC | 523 S Camino Del Rio, Suite B, Durango, CO 81303-6853 |
| Mark D Gaughan | Dermatology | Durango Dermatology and Dermatologic Surgery LLC | 523 S Camino Del Rio, Suite B, Durango, CO 81303-6853 |
| Kristin E Pogue | Physician Assistant | Durango Dermatology and Dermatologic Surgery LLC | 523 S Camino Del Rio, Suite B, Durango, CO 81303-6853 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Melinda Jean Jordeth | Physician Assistant | Southwest Colorado Mental Health Center Inc | 281 Sawyer Dr, Suite 100, Durango, CO 81303-3409 |
| Olive A Holmes | Clinical Social Worker | Southwest Colorado Mental Health Center Inc | 281 Sawyer Dr, Suite 100, Durango, CO 81303-3409 |
| Anne Dizenzo | Clinical Social Worker | Southwest Colorado Mental Health Center Inc | 281 Sawyer Dr, Suite 100, Durango, CO 81303-3409 |
| Peggy J Bayless | Clinical Social Worker | Southwest Colorado Mental Health Center Inc | 281 Sawyer Dr, Suite 100, Durango, CO 81303-3409 |
| Sherry L Ketner | Nurse Practitioner | Southwest Colorado Mental Health Center Inc | 281 Sawyer Dr, Suite 100, Durango, CO 81303-3409 |
| Brittany Brumfield | Clinical Social Worker | Southwest Colorado Mental Health Center Inc | 281 Sawyer Dr, Suite 100, Durango, CO 81303-3409 |
| Erick L Ireland | Physician Assistant | Southwest Colorado Mental Health Center Inc | 281 Sawyer Dr, Suite 100, Durango, CO 81303-3409 |
| Brian P Ensign | Clinical Social Worker | Southwest Colorado Mental Health Center Inc | 281 Sawyer Dr, Suite 100, Durango, CO 81303-3409 |
| Stephan J Kitson | Psychiatry | Southwest Colorado Mental Health Center Inc | 281 Sawyer Dr, Suite 100, Durango, CO 81303-3409 |
| Andrew D Rosenbach | Psychiatry | Southwest Colorado Mental Health Center Inc | 281 Sawyer Dr, Suite 100, Durango, CO 81303-3409 |
| Find all physicians in zip 81303 | |||
| City | DURANGO |
| Zip Code | 81303 |
| Specialty | DERMATOLOGY |
| City + Specialty | DURANGO + DERMATOLOGY |
Please comment or provide details below to improve the information on Scott C Wickless.
| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.