Provider Demographics
NPI:1992841894
Name:DICKINSON, JAMES C (PA)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:C
Last Name:DICKINSON
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:PO BOX 22000
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76902-7200
Mailing Address - Country:US
Mailing Address - Phone:325-658-1511
Mailing Address - Fax:325-481-2166
Practice Address - Street 1:4251 SUNSET DR
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76904-5653
Practice Address - Country:US
Practice Address - Phone:325-481-2226
Practice Address - Fax:325-481-2227
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2015-07-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXPA09830363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8031NQOtherBCBS