Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Dr. Derek Walter Nickerson, MD

Individual provider MOHS-Micrographic Surgery Physician · NPI 1265895619

Dr. Derek Walter Nickerson, MD is a Micrographic Dermatologic Surgery (Mds) in San Diego, California. Graduated from New York Medical College in 2016, 10 years ago. Practices with Grossmont Dermatology Medical Clinic, a 10-clinician group and accepts Medicare assignment. Licensed in California.

Years since qualifying
10
Trained at
New York Medical College
Licensed in
CA
In the registry since
2016
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

5550 Carmel Mountain Rd
San Diego, CA 92130-4853
Phone: (858) 943-2540
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

MOHS-Micrographic Surgery Physician (primary) Taxonomy 207ND0101X · Licence A171167 (CA)

Record details

NPI number1265895619
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorYes
NPI enumeratedApril 2, 2016
Last updated in NPPESMay 18, 2025
Certification dateMay 18, 2025

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyMICROGRAPHIC DERMATOLOGIC SURGERY (MDS)
Also practisesDERMATOLOGY
Medical schoolNEW YORK MEDICAL COLLEGE
Graduated 2016 (10 years in practice)
Group practice Grossmont Dermatology Medical Clinic — 10 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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