Individual
DR. TY DICKERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
100 N MEDICAL DR, PCMC, INPATIENT MEDICINE DIVISION, SALT LAKE CITY, UT 84113-1103
(801) 588-3813
Mailing address
1842 S 1100 E, SALT LAKE CITY, UT 84105-3414
(585) 224-5122
(801) 662-3664
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
6279497-1205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02181735
—
NY
Enumeration date
07/09/2006
Last updated
10/20/2021
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