Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207T00000X | Neurosurgeon | DR.0054873 | CO |
Y | 207T00000X | Neurosurgeon | G84805 | CA |
NPI | 1083669592 |
---|---|
Provider Name | Dr. Lawrence David Dickinson |
First Address | Danville, CA 94526-6258 |
Second Address | Castro Valley, CA 94546 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2006 |
Last Update Date | 17/03/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
75639700 | (05) | CO |
F84189 | (02) |