Provider Demographics
NPI:1720398985
Name:JAMES W DICKEY III MD INC
Entity Type:Organization
Organization Name:JAMES W DICKEY III MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATION SECRETARY
Authorized Official - Prefix:MRS
Authorized Official - First Name:LEILA
Authorized Official - Middle Name:K
Authorized Official - Last Name:DICKEY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:831-754-2238
Mailing Address - Street 1:258 A SAN JOSE ST
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93901
Mailing Address - Country:US
Mailing Address - Phone:831-754-2238
Mailing Address - Fax:831-754-0629
Practice Address - Street 1:258 A SAN JOSE ST
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93901
Practice Address - Country:US
Practice Address - Phone:831-754-2238
Practice Address - Fax:831-754-0629
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-20
Last Update Date:2010-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00G378420174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4131823Medicaid
CAE93112Medicare UPIN