Provider Demographics
NPI:1194755363
Name:SHEKER-DICKSON, KIMBERLY K (DO)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:K
Last Name:SHEKER-DICKSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:S
Other - Last Name:DICKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:1628 PALM AVE BAY URGENT
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92154-1027
Mailing Address - Country:US
Mailing Address - Phone:619-591-9999
Mailing Address - Fax:
Practice Address - Street 1:1628 PALM AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92154-1027
Practice Address - Country:US
Practice Address - Phone:619-591-9999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4055207P00000X
CA20A7995207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ867640Medicaid
CACB244891OtherMEDICARE
AZXPY199939Medicaid
AZ867640Medicaid