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NPI Code Detail

MEDICARE: DEAN JOHN NICKLES MD

MEDICARE: DEAN JOHN NICKLES MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207RC0200XCritical Care Medicine (Internal Medicine) PhysicianG44039CA
2207R00000XInternal Medicine PhysicianG44039CA

General Provider Information

NPI Number : 1255390050
Entity Type Code : Individual
Provider Name (Legal Business Name) : DEAN JOHN NICKLES MD
Provider Business Mailing Address
First Line : 5800 HOLLIS ST
Second Line :
City : EMERYVILLE
State : CA
Zip : 94608-2016
Country : US
Telephone Number : 510-806-2100
Fax Number : 510-806-2548
Provider Business Practice Location Address
First Line : 5800 HOLLIS ST
Second Line :
City : EMERYVILLE
State : CA
Zip : 94608-2016
Country : US
Telephone Number : 510-806-2100
Fax Number : 510-806-2548
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/21/2006
Last Update Date : 04/22/2024

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