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NPI Code Detail

MEDICARE: BENJAMIN OLSON DICKEY CAA

MEDICARE: BENJAMIN OLSON DICKEY 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
1367H00000XAnesthesiologist Assistant28512091GA
2367H00000XAnesthesiologist AssistantAA550FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1134760580
Entity Type Code : Individual
Provider Name (Legal Business Name) : BENJAMIN OLSON DICKEY CAA
Provider Business Mailing Address
First Line : 820 PRUDENTIAL DR STE 606
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32207-8208
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 800 PRUDENTIAL DR
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32207-8202
Country : US
Telephone Number : 904-202-2000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/07/2019
Last Update Date : 01/24/2023

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Directions to “ BENJAMIN OLSON DICKEY CAA” Practice Location

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