Healthcare Provider Details

I. General information

NPI: 1528488558
Provider Name (Legal Business Name): MAXWELL DICKEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2014
Last Update Date: 09/07/2023
Certification Date: 09/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

RAF LAKENHEATH FLIGHT MEDICINE CLINIC
RAF LAKENHEATH APO
09461
GB

IV. Provider business mailing address

RAF CENTRE OF AVIATION MEDICINE RAF HENLOW
HENLOW BEDFORDSHIRE
SG16 6DN
GB

V. Phone/Fax

Practice location:
  • Phone: 314-226-8010
  • Fax: 314-226-8022
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number28892
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code2083A0100X
TaxonomyAerospace Medicine Physician
License Number28892
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: