Individual
DR. GREGG ALAN DICKERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1514 E UNION ST, GREENVILLE, MS 38703-3248
(662) 332-6150
Mailing address
10542 LIETER PL, LONE TREE, CO 80124-9786
(303) 506-4753
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
17812
MS
2085R0001X
Radiation Oncology Physician
Primary
47586
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10781438
UNITEDHEALTHCARE CAQH
MS
01
—
896610
USA MANAGED CARE ORG
MN
Enumeration date
06/01/2005
Last updated
11/30/2016
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