Provider Demographics
NPI:1275727166
Name:JAMES P. DICKENS, M.D., INC.
Entity Type:Organization
Organization Name:JAMES P. DICKENS, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:PETER
Authorized Official - Last Name:DICKENS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-457-7424
Mailing Address - Street 1:701 HOWE AVE
Mailing Address - Street 2:BLDG H-50
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-4670
Mailing Address - Country:US
Mailing Address - Phone:916-457-7424
Mailing Address - Fax:916-457-9212
Practice Address - Street 1:701 HOWE AVE
Practice Address - Street 2:BLDG H-50
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-4670
Practice Address - Country:US
Practice Address - Phone:916-457-7424
Practice Address - Fax:916-457-9212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-04
Last Update Date:2012-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA55172207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG65739Medicare UPIN
CA00A551721Medicare PIN