DR. TY DICKERSON M.D.
NPI 1639102684
Pediatrics in Salt Lake City, UT

Q: What is Ty Dickerson's NPI number?

The NPI number for Ty Dickerson is 1639102684. It was assigned to this individual provider in the NPPES registry on July 9, 2006.

Q: What is Ty Dickerson's specialty?

The primary specialty registered for this NPI is Pediatrics with taxonomy code 208000000X.

Q: When was this NPI record last updated?

The NPPES record for Ty Dickerson was last updated on October 20, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since July 09, 2006

100 N MEDICAL DR, PCMC, INPATIENT MEDICINE DIVISION, SALT LAKE CITY, UT 84113(801) 588-3813 Get Directions Write a Review

NPPES record last updated: October 20, 2021. Verified against the NPPES registry weekly; last sync: November 01, 2026.

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About Dr. Ty Dickerson M.d. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. TY DICKERSON M.D. (NPI 1639102684) is an individual pediatrics provider in Salt Lake City, Utah, licensed in Utah (6279497-1205) and active in the NPI registry since July 2006.

NPPES Registry Identity

NPI1639102684

Entity TypeIndividualMale

Primary Taxonomy208000000X

Provider Legal NameDR. TY DICKERSONCredential: M.D.

Location Address100 N MEDICAL DR, PCMC, INPATIENT MEDICINE DIVISIONSalt Lake City, UT 84113-1103

Mailing Address1842 S 1100 ESalt Lake City, UT 84105-3414 · (585) 224-5122 · Fax (801) 662-3664

Phone(801) 588-3813

Sole ProprietorNo

Enumeration DateJuly 9, 2006

Last NPPES UpdateOctober 20, 2021

NPPES CertifiedOctober 20, 2021

✔ NPI 1639102684 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPediatricsAllopathic & Osteopathic Physicians

Taxonomy Code208000000X

License✔ Licensed in UT · 6279497-1205

Definition

A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development.

100 N MEDICAL DR, Salt Lake City, UT 84113

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Other Identifiers 1

Medicaid02181735NY

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MRS. LISA ANN RUNYON CPNP

Nurse Practitioner (Pediatrics)

100 N MEDICAL DR, TRAUMA SERVICES
SALT LAKE CITY, UT 84113

Salt Lake County (801) 662-2993

KATHERINE A HUGHES OT

Occupational Therapist

100 N MEDICAL DR
SLC, UT 84113

Salt Lake County (801) 588-2000

LINDA M LAMBERT A.P.R.N.

Nurse Practitioner