Healthcare Provider Details

I. General information

NPI: 1568401685
Provider Name (Legal Business Name): DUANE DICKENS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 12/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3038 OLIVE RD
TROTWOOD OH
45426-2640
US

IV. Provider business mailing address

3038 OLIVE RD
TROTWOOD OH
45426-2640
US

V. Phone/Fax

Practice location:
  • Phone: 937-208-7050
  • Fax: 937-208-7031
Mailing address:
  • Phone: 937-208-7050
  • Fax: 937-208-7031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number35061901
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35.061901
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: