Provider Demographics
NPI:1083669592
Name:DICKINSON, LAWRENCE DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:DAVID
Last Name:DICKINSON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1320 EL CAPITAN DR
Mailing Address - Street 2:# 300
Mailing Address - City:DANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94526-6258
Mailing Address - Country:US
Mailing Address - Phone:510-886-3138
Mailing Address - Fax:510-373-1616
Practice Address - Street 1:20055 LAKE CHABOT RD
Practice Address - Street 2:# 110
Practice Address - City:CASTRO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94546
Practice Address - Country:US
Practice Address - Phone:510-886-3138
Practice Address - Fax:510-373-1616
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2016-03-17
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Provider Licenses
StateLicense IDTaxonomies
CAG84805207T00000X
CODR.0054873207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO75639700Medicaid
CO396813YLB8Medicare PIN
F84189Medicare UPIN
CO75639700Medicaid