Healthcare Provider Details

I. General information

NPI: 1942287735
Provider Name (Legal Business Name): BRETT DICKINSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/22/2005
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 N LINCOLN ST
DESLOGE MO
63601-3524
US

IV. Provider business mailing address

216 N LINCOLN ST
DESLOGE MO
63601-3524
US

V. Phone/Fax

Practice location:
  • Phone: 573-952-8470
  • Fax: 573-565-0025
Mailing address:
  • Phone: 573-952-8470
  • Fax: 573-565-0025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2004030203
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: