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General NPI Number Information
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NPI Number | 1083834428
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Entity Type | Organization
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Legal Business Name | DONALD G. DICKEN, MD, PC
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Dates
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Enumeration Date | 04/26/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1200 N. 14TH AVE SUITE 275
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City | PASCO
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State | WA
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Zip | 99301-4079
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Country | US
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Telephone | 509-545-0414
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Fax | 509-545-9398
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Provider Business Mailing Address
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Address Line | 1200 N. 14TH AVE SUITE 275
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City | PASCO
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State | WA
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Zip | 99301-4079
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Country | US
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Telephone | 509-545-0414
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Fax | 509-545-9398
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. KATHLEEN MARIE MOREHOUSE
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Credential |
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Telephone | 509-545-0414
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | MD00028507
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License Number State | WA
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