Provider Demographics
NPI:1215956776
Name:DICKENS, JAMES P (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:P
Last Name:DICKENS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:701 HOWE AVE
Mailing Address - Street 2:BLDG H-50
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-4670
Mailing Address - Country:US
Mailing Address - Phone:916-457-7424
Mailing Address - Fax:916-457-9212
Practice Address - Street 1:701 HOWE AVE
Practice Address - Street 2:BLDG H-50
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-4670
Practice Address - Country:US
Practice Address - Phone:916-457-7424
Practice Address - Fax:916-457-9212
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2012-03-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA55172207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG65739Medicare UPIN