Healthcare Provider Details

I. General information

NPI: 1598880254
Provider Name (Legal Business Name): ANN T DICKSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 03/09/2021
Certification Date: 03/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 BANNOCK ST
DENVER CO
80204-4597
US

IV. Provider business mailing address

91 S CLARKSON ST
DENVER CO
80209-2119
US

V. Phone/Fax

Practice location:
  • Phone: 303-602-4000
  • Fax:
Mailing address:
  • Phone: 303-715-0563
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number30412
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number30412
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: