MEDICARE: DR. JESSIE JAMES DICKENS 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
1	207X00000X	Orthopaedic Surgery Physician	15765	NV
2	207X00000X	Orthopaedic Surgery Physician	A135648	CA
3	207X00000X	Orthopaedic Surgery Physician	P6377	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P6377	OTHER	TX	STATE LICENSE
2	1215254156	OTHER	TX	NPI

General Provider Information

NPI Number	:	1215254156
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JESSIE JAMES DICKENS MD

Provider Business Mailing Address
First Line	:	5615 DEAUVILLE BLVD
Second Line	:	STE 220
City	:	MIDLAND
State	:	TX
Zip	:	79706-2870
Country	:	US
Telephone Number	:	432-686-0321
Fax Number	:	432-686-0664

Provider Business Practice Location Address
First Line	:	5615 DEAUVILLE BLVD
Second Line	:	STE 220
City	:	MIDLAND
State	:	TX
Zip	:	79706-2870
Country	:	US
Telephone Number	:	432-686-0321
Fax Number	:	432-686-0664

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/03/2010
Last Update Date	:	09/08/2020

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Directions to “ DR. JESSIE JAMES DICKENS MD” Practice Location

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