Provider Demographics
NPI:1215254156
Name:DICKENS, JESSIE JAMES (MD)
Entity type:Individual
Prefix:DR
First Name:JESSIE
Middle Name:JAMES
Last Name:DICKENS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:5615 DEAUVILLE BLVD
Mailing Address - Street 2:STE 220
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79706-2870
Mailing Address - Country:US
Mailing Address - Phone:432-686-0321
Mailing Address - Fax:432-686-0664
Practice Address - Street 1:5615 DEAUVILLE BLVD
Practice Address - Street 2:STE 220
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79706-2870
Practice Address - Country:US
Practice Address - Phone:432-686-0321
Practice Address - Fax:432-686-0664
Is Sole Proprietor?:No
Enumeration Date:2010-05-03
Last Update Date:2020-09-08
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Provider Licenses
StateLicense IDTaxonomies
NV15765207X00000X
CAA135648207X00000X
TXP6377207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP6377OtherSTATE LICENSE
TX1215254156OtherNPI