Provider Demographics
NPI:1851950257
Name:DICKERSON, STEVEN DANIEL
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:DANIEL
Last Name:DICKERSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:353 E PARK AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92020-3944
Mailing Address - Country:US
Mailing Address - Phone:623-888-4787
Mailing Address - Fax:
Practice Address - Street 1:353 E PARK AVE STE 104
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92020-3944
Practice Address - Country:US
Practice Address - Phone:623-888-4787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-10
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE5874213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery