Individual
RYAN D DICKERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
500 RUE DE LA VIE ST, SUITE 100, BATON ROUGE, LA 70817-5126
(225) 201-2000
(225) 201-2110
Mailing address
500 RUE DE LA VIE ST, SUITE 100, BATON ROUGE, LA 70817-5126
(225) 201-2000
(225) 201-2110
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
200880
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
200880
LA MEDICAL LICENSE
LA
01
—
M2605
TX MEDICAL LICENSE
TX
Enumeration date
07/26/2006
Last updated
09/27/2012
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