Provider Demographics
NPI:1861448607
Name:DICKERSON, WILLIAM JOHN II (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:JOHN
Last Name:DICKERSON
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1 EDWARD ST
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MA
Mailing Address - Zip Code:02021-2303
Mailing Address - Country:US
Mailing Address - Phone:781-828-3533
Mailing Address - Fax:781-828-2471
Practice Address - Street 1:4302 W BROWARD BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317-3780
Practice Address - Country:US
Practice Address - Phone:954-771-3433
Practice Address - Fax:954-771-9911
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-25
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME64924207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2719029 00Medicaid
FL52084OtherBLUE CROSS & BLUE SHIELD
A66290Medicare UPIN
FL2719029 00Medicaid