Individual
ELLIOT DICKERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
10800 E GEDDES AVE STE 300, ENGLEWOOD, CO 80112-3895
(303) 761-9190
(720) 874-4462
Mailing address
10800 E GEDDES AVE STE 300, ENGLEWOOD, CO 80112-3895
(303) 761-9190
(720) 874-4462
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
04-40742
KS
2085R0202X
Diagnostic Radiology Physician
30587
NE
2085R0202X
Diagnostic Radiology Physician
Primary
59963
CO
2085R0202X
Diagnostic Radiology Physician
A143231
CA
2085R0202X
Diagnostic Radiology Physician
MD19673
HI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
111257116
MEDICARE
KS
05
—
201195600A
—
KS
01
—
646349
MEDICARE
CO
01
—
646400
MEDICARE
CO
01
—
646435
MEDICARE
CO
01
—
646456
MEDICARE
CO
01
—
646494
MEDICARE
CO
01
—
646579
MEDICARE
CO
05
—
9000159280
—
CO
01
—
KA3249107
MEDICARE
KS
01
—
NA1214130
MEDICARE
NE
01
—
NA1215131
MEDICARE
NE
01
—
NA2517108
MEDICARE
NE
Enumeration date
04/11/2011
Last updated
01/24/2023
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