Individual
THOMAS A DICKINSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1055 N 500 W, SUITE 100 BLDG B, PROVO, UT 84604-3305
(801) 374-1268
(801) 812-5454
Mailing address
1055 N 500 W, CREDENTIALING DEPARTMENT, PROVO, UT 84604-3305
(801) 354-8225
(801) 418-0941
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
1660021205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0049
DMBA
UT
01
—
100002620
PALMETTO GBA
UT
01
—
107006219101
IHC HEALTHPLANS
UT
01
—
29-00040
UNITED HEALTHCARE
UT
01
—
5285
PEHP
UT
01
—
QM0000009178
ALTIUS
UT
Enumeration date
05/04/2006
Last updated
11/27/2023
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