Ty Dickerson is a Pediatrics in Salt Lake City, Utah. Ty Dickerson practices all healthcare services and medical treatments related to Pediatrics. The NPI Number for Ty Dickerson is 1639102684. The last update date is 2021-10-20.
Ty Dickerson's current location address is 100 N Medical Dr, Salt Lake City, Utah. You can contact this provider via phone number 8015883813. The mailing address for Ty Dickerson is 100 N Medical Dr, Salt Lake City, Utah. To know further, please read the information below!
Provider Profile Detail
| Provider Name | Ty Dickerson |
|---|---|
| Address | 100 N Medical Dr, Salt Lake City, Utah |
| Phone Number | 8015883813 |
| Fax Number | |
| Sole Proprietor | N |
| Credentials | M.D. |
NPI Number Detail
| NPI Number | 1639102684 |
|---|---|
| Provider Enumeration Date | 2006-07-09 |
| Last Updated Date | 2021-10-20 |
Provider Mailing Address Detail
| Address | 100 N Medical Dr |
|---|---|
| City | Salt Lake City |
| State | Utah (UT) |
| Post Code | 841131103 |
| Phone Number | 8015883813 |
| Fax Number |
Provider's Primary Taxonomy Detail
| Speciality | Pediatrics |
|---|---|
| Taxonomy | 208000000X |
| Licence No | 6279497-1205 |
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Definition: A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and |
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Provider's Other Legacy Identifiers
| Identifier | Identifier Type | Identifier State | Identifier Issuer |
|---|---|---|---|
| 2181735 | NY | -- |
Post Comment/ Review Below
What is the Ty Dickerson's 1639102684?
The Ty Dickerson's NPI (National Provider Identifier) Number is 1639102684. This unique 10-digit identification number is assigned to health care providers by the Centers for Medicare & Medicaid Services (CMS).
Could you please share the complete physical address where Ty Dickerson is geographically located?
The Ty Dickerson is physically situated at the following location: 100 N Medical Dr, Salt Lake City, UT, 841131103.
What is Ty Dickerson's specialized field of practice, and what is the corresponding taxonomy classification code?
The Ty Dickerson's area of specialization is Pediatrics, and the corresponding taxonomy code that categorizes this field of practice is 208000000X.
On what date did Ty Dickerson receive its 1639102684 assignment from the Centers for Medicare & Medicaid Services?
The Ty Dickerson was assigned its 1639102684 on 2006-07-09, which is the date when this unique identifier was issued to the organization by the Centers for Medicare & Medicaid Services.
When was the Ty Dickerson's information last updated?
The Ty Dickerson's information was last updated on 2021-10-20.