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General NPI Number Information
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NPI Number | 1295098416
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Entity Type | Individual
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Provider Name | TYLER LEE DICKEY M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/21/2012
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Last Update Date | 01/19/2023
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Provider Practice Location Address
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Address Line | 6 13TH AVE E
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City | POLSON
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State | MT
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Zip | 59860-5315
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Country | US
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Telephone | 406-883-5680
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Fax | 406-883-8910
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Provider Business Mailing Address
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Address Line | PO BOX 262
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City | LIBERTY LAKE
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State | WA
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Zip | 99019-0262
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Country | US
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Telephone | 406-883-5680
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Fax | 406-883-8910
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 10229A
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License Number State | WY
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 4301101289
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | MED-PHYS-LIC-92059
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License Number State | MT
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