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General NPI Number Information
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NPI Number | 1831517317
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Entity Type | Individual
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Provider Name | SAMUEL BARNABAS DICKMANN MD
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Gender | Male
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Dates
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Enumeration Date | 04/02/2014
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Last Update Date | 12/22/2023
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Provider Practice Location Address
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Address Line | 5123 4TH AVENUE CIR E
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City | BRADENTON
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State | FL
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Zip | 34208-5620
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Country | US
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Telephone | 941-744-5510
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Fax | 941-744-5166
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Provider Business Mailing Address
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Address Line | 5123 4TH AVENUE CIR E
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City | BRADENTON
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State | FL
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Zip | 34208-5620
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Country | US
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Telephone | 941-744-5510
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Fax | 941-744-5166
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ME129516
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License Number State | FL
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