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General NPI Number Information
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NPI Number | 1780623298
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Entity Type | Individual
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Provider Name | ROBERT DICKEY CRNA
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Gender | Male
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Dates
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Enumeration Date | 06/06/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 295 N BREIEL BLVD
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City | MIDDLETOWN
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State | OH
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Zip | 45042-3807
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Country | US
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Telephone | 513-425-0930
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Fax | 513-425-0960
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Provider Business Mailing Address
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Address Line | PO BOX 181131
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City | FAIRFIELD
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State | OH
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Zip | 45018-1131
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Country | US
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Telephone | 513-874-2686
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Fax | 513-874-2686
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | NA022585
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License Number State | OH
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