MEDICARE: JAMES C DICKINSON PA

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	363A00000X	Physician Assistant	PA09830	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8031NQ	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1992841894
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES C DICKINSON PA

Provider Business Mailing Address
First Line	:	PO BOX 22000
Second Line	:
City	:	SAN ANGELO
State	:	TX
Zip	:	76902-7200
Country	:	US
Telephone Number	:	325-658-1511
Fax Number	:	325-481-2166

Provider Business Practice Location Address
First Line	:	4251 SUNSET DR
Second Line	:
City	:	SAN ANGELO
State	:	TX
Zip	:	76904-5653
Country	:	US
Telephone Number	:	325-481-2226
Fax Number	:	325-481-2227

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

Provider Enumeration Date	:	01/29/2007
Last Update Date	:	07/22/2015

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