Individual
DR. DAVID RAY DEDRICKSON
Active
Individual
DR. DAVID RAY DEDRICKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
184965-1205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100505581
—
NV
05
—
10536
—
UT
05
—
120727000
—
WY
05
—
807116200
—
ID
05
—
922890
—
AZ
01
—
P00199660
RR MEDICARE
UT
01
—
P00651526
RR MEDICARE
UT
Enumeration date
08/12/2005
Last updated
02/19/2019
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