Provider Demographics
NPI:1225598675
Name:DICKMAN, JEFFREY (DO)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:DICKMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5700 W OLIVE AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85302-3147
Mailing Address - Country:US
Mailing Address - Phone:623-299-9540
Mailing Address - Fax:623-299-9530
Practice Address - Street 1:4801 E MCDOWELL RD STE 150
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85008-7725
Practice Address - Country:US
Practice Address - Phone:602-954-3919
Practice Address - Fax:602-954-3670
Is Sole Proprietor?:No
Enumeration Date:2019-03-21
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ009276207N00000X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology