Provider Demographics
NPI:1568475002
Name:DICKSON, JAMES E JR (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:E
Last Name:DICKSON
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 1:3030 NACOGDOCHES RD STE 101
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-4502
Mailing Address - Country:US
Mailing Address - Phone:210-826-9599
Mailing Address - Fax:210-826-9828
Practice Address - Street 1:3030 NACOGDOCHES RD STE 101
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-4502
Practice Address - Country:US
Practice Address - Phone:210-826-9599
Practice Address - Fax:210-826-9828
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ55632084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0095EPOtherBLUE CROSS BLUE SHIELD
TX113684801Medicaid
TXF92412Medicare UPIN