Individual
DR. DANIEL JACKSON DICKMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
190 E BANNOCK ST, BOISE, ID 83712-6241
(208) 381-2809
(208) 381-1791
Mailing address
2894 W NEFF ST, BOISE, ID 83703-5404
(208) 794-0909
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
009081
AZ
2085R0202X
Diagnostic Radiology Physician
Primary
O-1709
ID
208600000X
Surgery Physician
R2701
AZ
390200000X
Student in an Organized Health Care Education/Training Program
—
NM
Other
Enumeration date
06/14/2016
Last updated
07/08/2022
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