Provider Demographics
NPI:1093844649
Name:HILL, DICKIE LYNN (DO)
Entity type:Individual
Prefix:DR
First Name:DICKIE
Middle Name:LYNN
Last Name:HILL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:821 E 2ND ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:BENICIA
Mailing Address - State:CA
Mailing Address - Zip Code:94510-3344
Mailing Address - Country:US
Mailing Address - Phone:707-745-3785
Mailing Address - Fax:707-746-1770
Practice Address - Street 1:821 E 2ND ST
Practice Address - Street 2:SUITE 104
Practice Address - City:BENICIA
Practice Address - State:CA
Practice Address - Zip Code:94510-3344
Practice Address - Country:US
Practice Address - Phone:707-745-3785
Practice Address - Fax:707-746-1770
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A4946207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0631402OtherCHAMPUS
0631402OtherCHAMPUS
E29238Medicare UPIN