Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | A55172 | CA |
NPI | 1215956776 |
---|---|
Provider Name | James P Dickens |
First Address | Sacramento, CA 95825-4670 |
Second Address | Sacramento, CA 95825-4670 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2006 |
Last Update Date | 14/03/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G65739 | (02) | CA |