NPI 1528039377 · live from the CMS NPI Registry
Jason Brent Dickerson, DPM
Podiatrist, Foot & Ankle Surgery in Salt Lake City, UT. National Provider Identifier 1528039377, active.
NPI record
| NPI | 1528039377 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Podiatrist, Foot & Ankle Surgery 213ES0103X |
| Practice location | 6360 S 3000 E, Ste 210, Salt Lake City, UT 84121 |
| Practice phone | 801-265-0600 |
| Enumerated | January 30, 2006 |
| Last updated | December 6, 2017 |
| Sole proprietor | Yes |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Podiatrist, Foot & Ankle Surgery primary | 213ES0103X | 4830364-0501 (UT) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.