Individual
DR. JACOB JOHN DICKINSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
8111 S EMERSON AVE, INDIANAPOLIS, IN 46237-8601
(317) 528-8148
Mailing address
PO BOX 7112, INDIANAPOLIS, IN 46207-7112
(317) 528-8148
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
01075221A
IN
390200000X
Student in an Organized Health Care Education/Training Program
4301100480
MI
Other
Enumeration date
07/04/2012
Last updated
03/24/2021
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