MEDICARE: ALEXANDER JAMES DICKERSON CAA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367H00000X	Anesthesiologist Assistant	AA827	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104602010
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXANDER JAMES DICKERSON CAA

Provider Business Mailing Address
First Line	:	2995 DREW ST
Second Line	:
City	:	CLEARWATER
State	:	FL
Zip	:	33759-3012
Country	:	US
Telephone Number	:	727-281-9065
Fax Number	:

Provider Business Practice Location Address
First Line	:	3001 W DR MARTIN LUTHER KING JR BLVD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33607-6307
Country	:	US
Telephone Number	:	813-350-7244
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/06/2023
Last Update Date	:	03/10/2026

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