Provider Demographics
NPI:1346218120
Name:DICKASON, TIMOTHY JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:JAMES
Last Name:DICKASON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1125 BARTOW RD STE 101A
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33801-5845
Mailing Address - Country:US
Mailing Address - Phone:281-221-1823
Mailing Address - Fax:
Practice Address - Street 1:1125 BARTOW RD
Practice Address - Street 2:STE 101
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33801-5852
Practice Address - Country:US
Practice Address - Phone:863-683-7171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2010-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL101101207ZP0102X, 207ZH0000X
TXM7144207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZH0000XAllopathic & Osteopathic PhysiciansPathologyHematology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000658200Medicaid
FL1346218120Medicare PIN