Individual
J BROOKS DICKERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2600 FERRY ST, LAFAYETTE, IN 47904-3055
(765) 448-8000
(765) 838-4698
Mailing address
PO BOX 5545, LAFAYETTE, IN 47903-5545
(765) 448-8000
(765) 448-8085
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
01028572
IN
208M00000X
Hospitalist Physician
Primary
01028572A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000642936
ANTHEM PROVIDER NUMBER
IN
05
—
100083060
—
IN
Enumeration date
11/01/2006
Last updated
02/08/2021
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