Provider Demographics
NPI:1073792248
Name:WILLIAM O DICKEY MD
Entity type:Organization
Organization Name:WILLIAM O DICKEY MD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:OLIVER
Authorized Official - Last Name:DICKEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-840-9690
Mailing Address - Street 1:9397 CROWN CREST BLVD STE 307
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80138-8788
Mailing Address - Country:US
Mailing Address - Phone:303-840-9690
Mailing Address - Fax:303-840-9617
Practice Address - Street 1:9397 CROWN CREST BLVD STE 307
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80138-8788
Practice Address - Country:US
Practice Address - Phone:303-840-9690
Practice Address - Fax:303-840-9617
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-24
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO41517207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO17071038Medicaid
CO17071038Medicaid