Provider Demographics
NPI:1154430957
Name:DICKINS, QUENTIN STOKES JR (MD)
Entity type:Individual
Prefix:
First Name:QUENTIN
Middle Name:STOKES
Last Name:DICKINS
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1112 N VAN BUREN AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:OTTUMWA
Mailing Address - State:IA
Mailing Address - Zip Code:52501-6416
Mailing Address - Country:US
Mailing Address - Phone:641-682-8302
Mailing Address - Fax:641-682-6534
Practice Address - Street 1:1112 N VAN BUREN AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:OTTUMWA
Practice Address - State:IA
Practice Address - Zip Code:52501-6416
Practice Address - Country:US
Practice Address - Phone:641-682-8302
Practice Address - Fax:641-682-6534
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA224022084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0183624Medicaid
IA50078Medicare ID - Type Unspecified
A01820Medicare UPIN