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Ty Dickerson, M.D.
NPI 1639102684 · Pediatrics Physician · Salt Lake City, UT
Ty Dickerson, M.D. is a Pediatrics Physician provider in Salt Lake City, UT (NPI 1639102684).
Provider details
- NPI number
- 1639102684
- Entity type
- Individual
- Primary specialty
- Pediatrics PhysicianAllopathic & Osteopathic Physicians
- Credential
- M.D.
- Sex
- Male
- Sole proprietor
- No
- License
- 6279497-1205 (UT)
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Profile Score
Detailed profile(91/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
19 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
100 N Medical Dr
Pcmc, Inpatient Medicine Division
Salt Lake City, UT 84113-1103
Phone: (801) 588-3813
Street-level locationGet directions
Mailing address
1842 S 1100 E
Salt Lake City, UT 84105-3414
Registry dates
- Enumerated
- 2006-07-09
- Last updated
- 2021-10-20
- Certified
- 2021-10-20
Frequently asked questions
- What is Ty Dickerson's NPI number?
- Ty Dickerson's National Provider Identifier (NPI) is 1639102684, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.
- What is Ty Dickerson's specialty?
- Ty Dickerson is listed in the NPPES registry with a primary specialty of Pediatrics Physician (Allopathic & Osteopathic Physicians).
- Where is Ty Dickerson located?
- Ty Dickerson's practice location on file with NPPES is 100 N Medical Dr, Salt Lake City, UT 84113-1103.
- What is Ty Dickerson's phone number?
- The practice phone number listed in the NPPES registry for Ty Dickerson is (801) 588-3813.
- Is Ty Dickerson's NPI active?
- Yes — Ty Dickerson's NPI (1639102684) is active in the NPPES registry as of the last update on 2021-10-20.
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.