Healthcare Provider Details

I. General information

NPI: 1780374652
Provider Name (Legal Business Name): TREVOR ALEXANDER DICKEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2023
Last Update Date: 05/12/2023
Certification Date: 05/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 N CAMPBELL AVE # 3301
TUCSON AZ
85724-0001
US

IV. Provider business mailing address

PO BOX 245073
TUCSON AZ
85724-5073
US

V. Phone/Fax

Practice location:
  • Phone: 520-626-6053
  • Fax:
Mailing address:
  • Phone: 520-626-6053
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberR80188
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: