MEDICARE: AMBER DICKSON

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
1	208D00000X	General Practice Physician	D250-012-84-844-0	FL

Other Identifiers

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

General Provider Information

NPI Number	:	1477146892
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMBER DICKSON

Provider Business Mailing Address
First Line	:	179 KINGS WAY
Second Line	:
City	:	SATELLITE BEACH
State	:	FL
Zip	:	32937-3259
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	179 KINGS WAY
Second Line	:
City	:	SATELLITE BEACH
State	:	FL
Zip	:	32937-3259
Country	:	US
Telephone Number	:	254-244-1660
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/17/2021
Last Update Date	:	02/17/2021

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Directions to “ AMBER DICKSON ” Practice Location

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