=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073792248
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WILLIAM O DICKEY MD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/24/2007
-----------------------------------------------------
Last Update Date | 02/29/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9397 CROWN CREST BLVD STE 307
-----------------------------------------------------
City | PARKER
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80138-8788
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-840-9690
-----------------------------------------------------
Fax | 303-840-9617
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9397 CROWN CREST BLVD STE 307
-----------------------------------------------------
City | PARKER
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80138-8788
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-840-9690
-----------------------------------------------------
Fax | 303-840-9617
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. WILLIAM OLIVER DICKEY
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 303-840-9690
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Y00000X
-----------------------------------------------------
Taxonomy Name | Otolaryngology Physician
-----------------------------------------------------
License Number | 41517
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------