Doctor Name: | DAVID SHAWN DICKINSON |
NPI Number: | 1861586745 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PA-C |
License Number: | 221 |
Business Practice Address: | 1 Inner Loop Road Jackson Lake Lodge Moran, WY - 830130000 |
Business Phone Number: | 3075432514 |
Business Fax Number: | |
Mailing Address: | 1 Inner Loop Road, Jackson Lake Lodge MORAN |
State: | WY |
Postal Code: | 830130000 |
Phone Number: | 3075432514 |
Fax Number: | |
NPI Enumeration Date: | 10/03/2006 |
NPI Last Update Date: | 06/09/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | 221 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WY |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |