Individual
MR. CHARLES EARL DICKERSON JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
2005 KNIGHT LANE BLDG H, NAVMEDSUPCOM ATTN: MED STAFF SERVICES, JACKSONVILLE, FL 32212-0140
(619) 532-6684
Mailing address
640 WILMINGTON DR, CHULA VISTA, CA 91914-4209
(301) 908-8904
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
840135
CA
367500000X
Certified Registered Nurse Anesthetist
Primary
4405
CA
Other
Enumeration date
06/26/2013
Last updated
06/26/2013
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