Provider Demographics
NPI:1396986782
Name:DYKES, LUCINDA JANE (MD)
Entity type:Individual
Prefix:DR
First Name:LUCINDA
Middle Name:JANE
Last Name:DYKES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LUCINDA
Other - Middle Name:JANE
Other - Last Name:POLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:80108 HAZELTON RD
Mailing Address - Street 2:
Mailing Address - City:COTTAGE GROVE
Mailing Address - State:OR
Mailing Address - Zip Code:97424-8520
Mailing Address - Country:US
Mailing Address - Phone:541-767-2679
Mailing Address - Fax:541-767-3679
Practice Address - Street 1:913 NW GARDEN VALLEY BLVD
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97471-6523
Practice Address - Country:US
Practice Address - Phone:800-549-8387
Practice Address - Fax:541-440-1334
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-13
Last Update Date:2009-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM92-45208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics