Robert Ray Dickerson, MD

Primary specialty

Anesthesiology PhysicianTaxonomy code 207L00000X

License

ME52195 Issued in FL

Practice address

10080 Balaye Run Dr
Tampa, FL 33619-7902

Phone

(813) 490-6100

Fax

(813) 490-6105

NPI assigned

Aug 13, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1155427200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1266883200000",
    "number": "1679585004",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1033 DR MARTIN LUTHER KING JR ST N",
            "address_2": "STE. 108",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337011547",
            "telephone_number": "727-456-4250",
            "fax_number": "727-346-1044"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10080 BALAYE RUN DR",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336197902",
            "telephone_number": "813-490-6100",
            "fax_number": "813-490-6105"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DICKERSON",
        "first_name": "ROBERT",
        "middle_name": "RAY",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-13",
        "last_updated": "2010-02-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "FL",
            "license": "ME52195",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "048964600",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "07123",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AVMED",
            "identifier": "295449",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Regina Dibello, ARNP
• Magaly Paez Dicanio, A.P., D.O.M.,LMT
• Richard Lark Dicicco, M.D.
• Alexander James Dickerson, CAA
• Lara Dickerson, LCSW
• Savion Dickerson
• Tammy Marcellus Dickerson
• Shea R Dickey, RCSWI
• Stephen F Dickey, M.D
• Keely Marie Dickinson, CRNA

• Anesthesiology Physician in Tampa, FL
• Providers in Tampa, FL by specialty
• Anesthesiology Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 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.

Verify at the official NPI Registry.