Provider Demographics
NPI:1831517317
Name:DICKMANN, SAMUEL BARNABAS (MD)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:BARNABAS
Last Name:DICKMANN
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 1:5123 4TH AVENUE CIR E
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34208-5620
Mailing Address - Country:US
Mailing Address - Phone:941-744-5510
Mailing Address - Fax:941-744-5166
Practice Address - Street 1:5123 4TH AVENUE CIR E
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34208-5620
Practice Address - Country:US
Practice Address - Phone:941-744-5510
Practice Address - Fax:941-744-5166
Is Sole Proprietor?:No
Enumeration Date:2014-04-02
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME129516207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL020510500Medicaid