Healthcare Provider Details

I. General information

NPI: 1295098416
Provider Name (Legal Business Name): TYLER LEE DICKEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2012
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 W 5TH ST
SHERIDAN WY
82801-2705
US

IV. Provider business mailing address

1401 W 5TH ST
SHERIDAN WY
82801-2705
US

V. Phone/Fax

Practice location:
  • Phone: 307-672-1000
  • Fax:
Mailing address:
  • Phone: 307-672-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number4301101289
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMED-PHYS-LIC-92059
License Number StateMT
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number10229A
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: