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General NPI Number Information
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NPI Number | 1215041041
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Entity Type | Organization
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Legal Business Name | PATRICIA A. DICKERSON MD
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Dates
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Enumeration Date | 08/18/2006
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Last Update Date | 11/05/2012
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Provider Practice Location Address
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Address Line | 1299 E ALEX BELL RD
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City | CENTERVILLE
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State | OH
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Zip | 45459-2658
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Country | US
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Telephone | 937-436-1117
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Fax | 937-436-9576
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Provider Business Mailing Address
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Address Line | 1299 E ALEX BELL RD
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City | CENTERVILLE
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State | OH
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Zip | 45459-2658
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Country | US
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Telephone | 937-436-1117
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Fax | 937-436-9576
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Authorized Official
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Title or Position | OWNER
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Name | PATRICIA A DICKERSON
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Credential | MD
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Telephone | 937-436-1117
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number |
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License Number State |
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