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General NPI Number Information
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NPI Number | 1225296676
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Entity Type | Individual
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Provider Name | DWIGHT RAYMOND STICKNEY M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/01/2008
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Last Update Date | 06/01/2008
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Provider Practice Location Address
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Address Line | 5275 ASHBY LN
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City | GRANITE BAY
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State | CA
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Zip | 95746-9425
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Country | US
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Telephone | 916-600-5116
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Fax | 916-797-1583
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Provider Business Mailing Address
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Address Line | 5275 ASHBY LN
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City | GRANITE BAY
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State | CA
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Zip | 95746-9425
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Country | US
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Telephone | 916-600-5116
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Fax | 916-797-1583
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0203X
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Taxonomy Name | Therapeutic Radiology Physician
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License Number | C37059
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License Number State | CA
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