Healthcare Provider Details

I. General information

NPI: 1215956776
Provider Name (Legal Business Name): JAMES P DICKENS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 03/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 HOWE AVE BLDG H-50
SACRAMENTO CA
95825-4670
US

IV. Provider business mailing address

701 HOWE AVE BLDG H-50
SACRAMENTO CA
95825-4670
US

V. Phone/Fax

Practice location:
  • Phone: 916-457-7424
  • Fax: 916-457-9212
Mailing address:
  • Phone: 916-457-7424
  • Fax: 916-457-9212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberA55172
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: