Individual
BRANDON THOMAS DICKINSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1055 N 500 W STE 100, PROVO, UT 84604-3305
(801) 374-1268
(801) 812-5454
Mailing address
1055 N 500 W, ATTN CREDENTIALING, PROVO, UT 84604-3305
(801) 354-8225
(801) 418-0941
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
11676583-1205
UT
207RG0100X
Gastroenterology Physician
MD60587041
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1770825713
—
WA
Enumeration date
03/17/2013
Last updated
11/27/2023
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