Healthcare Provider Details

I. General information

NPI: 1497936397
Provider Name (Legal Business Name): DR S HOWARD DICKEY DO PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2007
Last Update Date: 06/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10201 HIGHWAY 16
COMANCHE TX
76442-4462
US

IV. Provider business mailing address

PO BOX 108
DE LEON TX
76444-0108
US

V. Phone/Fax

Practice location:
  • Phone: 254-879-4900
  • Fax:
Mailing address:
  • Phone: 254-879-4900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberK1416
License Number StateTX

VIII. Authorized Official

Name: DR. STEPHEN HOWARD DICKEY
Title or Position: P.A.
Credential: D.O.
Phone: 254-879-4900