Provider Demographics
NPI:1063454445
Name:DICKSON, TROY S (MD)
Entity type:Individual
Prefix:
First Name:TROY
Middle Name:S
Last Name:DICKSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 45680
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94145-0680
Mailing Address - Country:US
Mailing Address - Phone:530-344-2070
Mailing Address - Fax:530-295-0400
Practice Address - Street 1:4300 GOLDEN CENTER DR
Practice Address - Street 2:SUITE C
Practice Address - City:PLACERVILLE
Practice Address - State:CA
Practice Address - Zip Code:95667-6278
Practice Address - Country:US
Practice Address - Phone:530-344-2070
Practice Address - Fax:530-295-0400
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2015-10-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA79321207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A793210Medicare PIN
CAI42630Medicare UPIN
CA00A793210Medicaid