Provider Demographics
NPI:1467737866
Name:DICKINSON, JOSEPH ALAN (PA)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:ALAN
Last Name:DICKINSON
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:181 SANTA BARBARA WAY
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-4318
Mailing Address - Country:US
Mailing Address - Phone:407-697-2228
Mailing Address - Fax:561-626-9328
Practice Address - Street 1:3230 LAKE WORTH RD
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33461-6922
Practice Address - Country:US
Practice Address - Phone:561-964-0910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-17
Last Update Date:2011-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9106213363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant