Individual
JEFF S. DICKERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
815 W 1ST ST, RICHVILLE, MN 56576-7609
(218) 346-6309
Mailing address
815 W 1ST ST, RICHVILLE, MN 56576-7609
(218) 346-6309
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00-00000
MEDICA
MN
Enumeration date
08/03/2010
Last updated
08/03/2010
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