Provider Demographics
NPI:1487700779
Name:SICKLICK, JASON KEITH (MD)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:KEITH
Last Name:SICKLICK
Suffix:
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 1:3855 HEALTH SCIENCES DR., RM 2313, MAIL CODE: 0987
Mailing Address - Street 2:DEPT OF SURG, DIV OF SURG ONCOL, MOORES UCSD CANCER CTR
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92093-0987
Mailing Address - Country:US
Mailing Address - Phone:858-822-2124
Mailing Address - Fax:858-534-4813
Practice Address - Street 1:3855 HEALTH SCIENCES DR., RM 2313, MAIL CODE: 0987
Practice Address - Street 2:DEPT OF SURG, DIV OF SURG ONCOL, MOORES UCSD CANCER CTR
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92093-0987
Practice Address - Country:US
Practice Address - Phone:858-822-2124
Practice Address - Fax:858-534-4813
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-27
Last Update Date:2019-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY247995208600000X, 2086X0206X
CAA 112500208600000X, 2086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
No208600000XAllopathic & Osteopathic PhysiciansSurgery