Provider Demographics
NPI:1285623157
Name:DICKSON, ROLLAND COLLIER (MD)
Entity type:Individual
Prefix:DR
First Name:ROLLAND
Middle Name:COLLIER
Last Name:DICKSON
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 1:13400 E SHEA BLVD
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85259-5452
Mailing Address - Country:US
Mailing Address - Phone:480-301-8000
Mailing Address - Fax:480-342-2324
Practice Address - Street 1:13400 E SHEA BLVD
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85259-5452
Practice Address - Country:US
Practice Address - Phone:480-301-8000
Practice Address - Fax:480-342-2324
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN107082207RG0100X
MN30914207RG0100X
FLME60263207RG0100X
NH14538207RG0100X
AZ52624207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1016689Medicaid
FL378138100Medicaid
FL68756OtherBLUECROSS/BLUESHIELD
MNP01240217OtherRAILROAD MEDICARE
NH3077272Medicaid
FL100011024OtherRAILROAD MEDICARE
VT1016689Medicaid
MN100001057Medicare PIN
F48992Medicare UPIN
MNP01240217OtherRAILROAD MEDICARE