Provider Demographics
NPI:1891037289
Name:DICKMAN, JONATHAN ROSS (MD, PHD)
Entity Type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:ROSS
Last Name:DICKMAN
Suffix:
Gender:M
Credentials:MD, PHD
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Mailing Address - Street 1:2925 CHICAGO AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55407-1321
Mailing Address - Country:US
Mailing Address - Phone:612-262-9000
Mailing Address - Fax:
Practice Address - Street 1:233 GRAND AVE
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-2331
Practice Address - Country:US
Practice Address - Phone:651-241-5200
Practice Address - Fax:651-241-6427
Is Sole Proprietor?:No
Enumeration Date:2013-03-23
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN58327207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine