DR. DANE J DICKSON (NPI# 1669497194) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1669497194 |
| Entity Type | Individual |
| Full Name | DR. DANE J DICKSON |
| Credential | MD |
| Practice Address |
380 Walker Drive Rexburg ID 83440 |
| Mailing Address |
380 Walker Dr Rexburg ID 83440-1657 |
| Practice Telephone | 2083569559 |
| Practice Fax Number | 2083566601 |
| Mailing Telephone | 2083569559 |
| Mailing Fax Number | 2083566601 |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2008-01-24 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207RH0003X |
Internal Medicine Specialization: Hematology & Oncology |
M8118 | ID | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| ID | BLUE SHIELD | 000010032448 | 01 |
| ID | BLUE CROSS | 8J950 | 01 |
| Street Address |
380 WALKER DRIVE |
| City | REXBURG |
| State | ID |
| Zip Code | 83440 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235768490 | Henry's Fork Surgery Center Pllc | Clinic/Center | 23 Sawtelle Ave, Rexburg, ID 83440 | 2020-04-08 |
| 1952956906 | Shane Ellis Withers | Pharmacist | 164 E. Main, Rexburg, ID 83440 | 2019-08-06 |
| 1316392285 | Emma Anderson | Speech-Language Pathologist | 36 Professional Plaza Suite 110, Rexburg, ID 83440 | 2016-04-28 |
| 1851755524 | Sandra Frickey | Speech-Language Pathologist | 1087 Summers Drive, Premier Therapy Associates, Rexburg, ID 83440 | 2016-04-08 |
| 1275997215 | Kerry Denney | Counselor | 333 Walker Drive, Rexburg, ID 83440 | 2016-04-06 |
| 1467837583 | Wal-mart Stores, Inc. | Technician/Technologist | 303 E Moody Rd, Rexburg, ID 83440 | 2015-07-30 |
| 1649692609 | Tanabell Health Services, Inc. | Skilled Nursing Facility | 410 W 1st N, Rexburg, ID 83440 | 2014-01-10 |
| 1043652571 | Creed Simon Webster | Counselor | 30 S 2nd W, Rexburg, ID 83440 | 2013-07-25 |
| 1033461660 | James Cannon Allen Dds PC | Dentist | 106 E 1st North, Rexburg, ID 83440 | 2012-10-05 |
| 1417217316 | Shelby Dee Woolstenhulme | Speech-Language Pathologist | 450 E. Main Street, Rexburg, ID 83440 | 2012-05-24 |
| Find all providers in zip 83440 | ||||
| Taxonomy Code | 207RH0003X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Hematology & Oncology |
| An internist doctor of osteopathy that specializes in the treatment of the combination of hematology and oncology disorders. A doctor of osteopathy that is board eligible/certified by the American Osteopathic Board of Internal Medicine WAS able to obtain a Certificate of Special Qualifications in the field of Hematology and Oncology. The Certificate is NO longer offered. |
| Notes: Source: American Osteopathic Board of Internal Medicine, 2007. [7/1/2008: definiton added, source added; 7/1/2011: modified source] - Additional Resources: http://www.osteopathic.org/certification |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245382985 | Teton Oncology LLC | Internal Medicine | 380 Walker Dr, Rexburg, ID 83440-1657 | 2007-01-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891857512 | Nathan Bradley Adams | Internal Medicine | 2330 Desoto St, Idaho Falls, ID 83404-7570 | 2006-12-16 |
| 1669565669 | A. Richard Miranda | Internal Medicine | 706 N College Rd, Suite A, Twin Falls, ID 83301-5824 | 2006-10-02 |
| 1528075744 | Thomas J Leavitt | Internal Medicine | 284 Buck Run, Sagle, ID 83860 | 2006-08-01 |
| 1588696538 | Jonathan N Swerdloff | Internal Medicine | 308 E Hawaii Ave, Nampa, ID 83686-6013 | 2006-07-07 |
| 1508809252 | Daniel E Williams | Internal Medicine | 1250 Idaho St, Lewiston, ID 83501-1965 | 2006-06-13 |
| 1871558239 | Michael L Francisco | Internal Medicine | 651 Memorial Dr, Portneuf Cancer Center, Pocatello, ID 83201 | 2006-04-19 |
| 1669462362 | Mountain View Hospital LLC | Internal Medicine | 2325 Coronado St, Idaho Falls, ID 83404-7407 | 2005-10-24 |
| 1952307605 | David W. Ririe | Internal Medicine | 500 S 11th Ave Ste 100, Pocatello, ID 83201-4877 | 2005-06-27 |
| 1477020303 | Maria Teresa Cervantes-fullmer | Internal Medicine | 3245 Channing Way, Idaho Falls, ID 83404-7536 | 2018-10-29 |
| 1053765545 | Miranda Medical, Pllc | Internal Medicine | 706 N College Rd, Suite A, Twin Falls, ID 83301-5824 | 2016-04-20 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.