Provider Demographics
NPI:1487815601
Name:DICKUN, CHRISTAL M (MD)
Entity type:Individual
Prefix:
First Name:CHRISTAL
Middle Name:M
Last Name:DICKUN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:100 S HARBOR CITY BLVD
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-1319
Mailing Address - Country:US
Mailing Address - Phone:844-856-2585
Mailing Address - Fax:321-259-1223
Practice Address - Street 1:1400 ROCKLEDGE BLVD
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-2846
Practice Address - Country:US
Practice Address - Phone:321-735-8960
Practice Address - Fax:321-735-8964
Is Sole Proprietor?:No
Enumeration Date:2008-06-19
Last Update Date:2024-12-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NE25291207P00000X
CAA124247207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine