Provider Demographics
NPI:1013396852
Name:DICKINSON, JOSHUA (DO)
Entity Type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:
Last Name:DICKINSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2655 COLLINS DR
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-9687
Mailing Address - Country:US
Mailing Address - Phone:682-239-4121
Mailing Address - Fax:
Practice Address - Street 1:525 WESTERN AVE STE 203
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-4980
Practice Address - Country:US
Practice Address - Phone:501-327-4828
Practice Address - Fax:501-327-6899
Is Sole Proprietor?:No
Enumeration Date:2015-05-27
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE13375208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery