Individual
SCOTT C WICKLESS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1801 S OSPREY AVE UNIT 201, SARASOTA, FL 34239-3625
(941) 957-4767
(941) 955-7334
Mailing address
4919 MEMORIAL HWY STE 150, TAMPA, FL 33634-7516
(813) 333-1528
(813) 255-2818
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
OS15286
FL
207ZD0900X
Dermatopathology (Pathology) Physician
OS15286
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
107709300
—
FL
Enumeration date
08/12/2006
Last updated
03/06/2023
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