Dickinson, Jacob Lee

Dickinson, Jacob Lee is an individual health care provider with primary practice located at 901 Burnett Dr , Mountain Home AR 72653-2908. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Surgery, Allopathic & Osteopathic Physicians / Vascular Surgery. Allopathic & Osteopathic Physicians / Surgery is his primary health care specialty. Dickinson, Jacob Lee can be contacted via phone (870) 425-9120.

Contact Information

Primary practice address
901 Burnett Dr Mountain Home AR 72653-2908
Phone: (870) 425-9120
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Surgery 208600000X E-5452 Arkansas
Allopathic & Osteopathic Physicians / Vascular Surgery 2086S0129X E-5452 Arkansas

Profile Details

NPI number 1396866364
LBN Legal business name Dickinson, Jacob Lee
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 3rd, 2007
Last updated Aug 27th, 2013 - about 11 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1396866364 NPPES
Arkansas MEDICAID 168854001

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