Active NPI
Alfred Dickson, M.D.
- Surgery Physician
- Portland, OR
National Provider Identifier
1396069498
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- 72042
- Practice address
- 1132 SW 13TH Ave
Portland, OR 97205-1703 - Phone
- (503) 535-3890
- NPI assigned
- Mar 17, 2010
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | 72042 | OR | Primary |
Addresses
Primary practice location
1132 SW 13TH Ave
Portland, OR 97205-1703
Mailing address
5428 NW Wahkeena LN
Portland, OR 97229-7150
Phone (503) 614-8949
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 72042 | OR | MD | Surgery Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1268784000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1268784000000",
"number": "1396069498",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5428 NW WAHKEENA LN",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972297150",
"telephone_number": "503-614-8949"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1132 SW 13TH AVE",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972051703",
"telephone_number": "503-535-3890"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DICKSON",
"first_name": "ALFRED",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2010-03-17",
"last_updated": "2010-03-17",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "OR",
"license": "72042",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Portland, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.