Individual
DALE ALAN WICKSTRUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2003 CENTRE POINTE BLVD, TALLAHASSEE, FL 32308-4893
(850) 878-2273
(850) 671-5900
Mailing address
PO BOX 14446, TALLAHASSEE, FL 32317-4446
(850) 222-4858
(850) 431-6591
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
Primary
ME0035684
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
051677500
—
FL
Enumeration date
05/22/2006
Last updated
11/23/2015
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