Healthcare Provider Details

I. General information

NPI: 1194995167
Provider Name (Legal Business Name): DIXIE A. DOOLEY, DPM, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2008
Last Update Date: 03/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2633 COMMONS BLVD SUITE 110
BEAVERCREEK OH
45431-3827
US

IV. Provider business mailing address

2633 COMMONS BLVD SUITE 110
BEAVERCREEK OH
45431-3827
US

V. Phone/Fax

Practice location:
  • Phone: 937-433-9821
  • Fax: 937-433-1577
Mailing address:
  • Phone: 937-433-9821
  • Fax: 937-433-1577

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number36.001778
License Number StateOH

VIII. Authorized Official

Name: DR. DIXIE A DOOLEY
Title or Position: PRESIDENT / OWNER
Credential: DPM
Phone: 937-433-9821