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NPI Code Detail

MEDICARE: DR. RYAN SPENCER DICKERT MD

MEDICARE: DR. RYAN SPENCER DICKERT MD
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
1207Q00000XFamily Medicine PhysicianME129191FL

Other Identifiers

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

General Provider Information

NPI Number : 1306231212
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. RYAN SPENCER DICKERT MD
Provider Business Mailing Address
First Line : 1250 N VANTAGE POINT DR
Second Line :
City : CRYSTAL RIVER
State : FL
Zip : 34429-5736
Country : US
Telephone Number : 352-795-0644
Fax Number :
Provider Business Practice Location Address
First Line : 1250 N VANTAGE POINT DR
Second Line :
City : CRYSTAL RIVER
State : FL
Zip : 34429-5736
Country : US
Telephone Number : 352-795-0644
Fax Number : 352-795-5950
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/30/2015
Last Update Date : 06/10/2020

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