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General NPI Number Information
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NPI Number | 1407316821
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Entity Type | Individual
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Provider Name | JACOB LANE DICKINSON D.O.
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Gender | Male
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Dates
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Enumeration Date | 03/21/2019
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Last Update Date | 09/29/2025
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Provider Practice Location Address
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Address Line | 2121 PEASE ST STE 404
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City | HARLINGEN
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State | TX
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Zip | 78550-8338
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Country | US
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Telephone | 956-507-1920
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 5730
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City | BELFAST
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State | ME
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Zip | 04915-5700
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Country | US
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Telephone |
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Fax |
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | V9889
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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