Individual
SCOTT A. NICKLEBUR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
302 UNIVERSITY BLVD, ROUND ROCK, TX 78665-1032
(512) 509-0200
Mailing address
PO BOX 844658, DALLAS, TX 75284-4658
(254) 724-8800
Taxonomy
Speciality
Code
Description
License number
State
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
Primary
L3040
TX
207R00000X
Internal Medicine Physician
L3040
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
170178101
—
TX
05
—
170178102
—
TX
Enumeration date
05/19/2006
Last updated
01/07/2021
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