Healthcare Provider Details

I. General information

NPI: 1356412621
Provider Name (Legal Business Name): M. ALAN DICKENS, MD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2006
Last Update Date: 10/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2709 BLUE RIDGE RD SUITE 100
RALEIGH NC
27607-6462
US

IV. Provider business mailing address

2709 BLUE RIDGE RD SUITE 100
RALEIGH NC
27607-6462
US

V. Phone/Fax

Practice location:
  • Phone: 919-782-5400
  • Fax: 919-782-1680
Mailing address:
  • Phone: 919-782-5400
  • Fax: 919-782-1680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number9500885
License Number StateNC

VIII. Authorized Official

Name: DR. M ALAN DICKENS
Title or Position: PRESIDENT
Credential: MD
Phone: 919-782-5400