Provider Demographics
NPI:1851950257
Name:DICKERSON, STEVEN DANIEL (DPM)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:DANIEL
Last Name:DICKERSON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1785 W CRIMSON CLOVER LN
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-1469
Mailing Address - Country:US
Mailing Address - Phone:623-888-4787
Mailing Address - Fax:
Practice Address - Street 1:2345 E 8TH ST STE 105
Practice Address - Street 2:
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950-2866
Practice Address - Country:US
Practice Address - Phone:858-275-6320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-10
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE5874213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery