Provider Demographics
NPI:1568475002
Name:DICKSON, JAMES E JR (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:E
Last Name:DICKSON
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:12042 BLANCO RD
Mailing Address - Street 2:STE. 308
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-5440
Mailing Address - Country:US
Mailing Address - Phone:210-525-9945
Mailing Address - Fax:210-525-1469
Practice Address - Street 1:12042 BLANCO RD
Practice Address - Street 2:STE. 308
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-5440
Practice Address - Country:US
Practice Address - Phone:210-525-9945
Practice Address - Fax:210-525-1469
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXJ55632084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0095EPOtherBLUE CROSS BLUE SHIELD
TX0095EPOtherBLUE CROSS BLUE SHIELD
TXF92412Medicare UPIN