Healthcare Provider Details

I. General information

NPI: 1679743660
Provider Name (Legal Business Name): DIXIE A DOOLEY, DPM INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2008
Last Update Date: 03/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

69 N DIXIE DR SUITE B
VANDALIA OH
45377-2060
US

IV. Provider business mailing address

69 N DIXIE DR SUITE B
VANDALIA OH
45377-2060
US

V. Phone/Fax

Practice location:
  • Phone: 937-890-4934
  • Fax: 937-433-1577
Mailing address:
  • Phone: 937-890-4934
  • Fax: 937-433-1577

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number36001778
License Number StateOH

VIII. Authorized Official

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