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General NPI Number Information
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NPI Number | 1861448607
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Entity Type | Individual
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Provider Name | WILLIAM JOHN DICKERSON II MD
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Gender | Male
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Dates
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Enumeration Date | 05/25/2006
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Last Update Date | 02/18/2010
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Provider Practice Location Address
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Address Line | 4302 W BROWARD BLVD SUITE 200
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City | PLANTATION
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State | FL
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Zip | 33317-3780
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Country | US
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Telephone | 954-771-3433
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Fax | 954-771-9911
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Provider Business Mailing Address
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Address Line | 1 EDWARD ST
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City | CANTON
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State | MA
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Zip | 02021-2303
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Country | US
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Telephone | 781-828-3533
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Fax | 781-828-2471
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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 | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | ME64924
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License Number State | FL
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