Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Dr. Ty Dickerson, MD

Individual provider Pediatrics Physician · NPI 1639102684

Dr. Ty Dickerson, MD is a Pediatrics Physician in Salt Lake City, Utah. Licensed in Utah. Registered with an NPI since 2006.

Licensed in
UT
In the registry since
2006
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

See every abbreviation used in this directory →

Practice location Address checks out

100 N Medical Dr Pcmc Inpatient Medicine Division
Salt Lake City, UT 84113-1103
Phone: (801) 588-3813
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Pediatrics Physician (primary) Taxonomy 208000000X · Licence 6279497-1205 (UT)

Record details

NPI number1639102684
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorNo
NPI enumeratedJuly 9, 2006
Last updated in NPPESOctober 20, 2021
Certification dateOctober 20, 2021

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