Individual
JACOB LEE DICKINSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
901 BURNETT DR, MOUNTAIN HOME, AR 72653-2908
(870) 425-9120
Mailing address
901 BURNETT DR, MOUNTAIN HOME, AR 72653-2908
(870) 425-9120
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
E-5452
AR
2086S0129X
Vascular Surgery Physician
E-5452
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
168854001
—
AR
Enumeration date
04/03/2007
Last updated
08/27/2013
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