Provider Demographics
NPI:1194995167
Name:DIXIE A. DOOLEY, DPM, INC.
Entity type:Organization
Organization Name:DIXIE A. DOOLEY, DPM, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DIXIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:DOOLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:937-433-9821
Mailing Address - Street 1:2633 COMMONS BLVD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45431-3827
Mailing Address - Country:US
Mailing Address - Phone:937-433-9821
Mailing Address - Fax:937-433-1577
Practice Address - Street 1:2633 COMMONS BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45431-3827
Practice Address - Country:US
Practice Address - Phone:937-433-9821
Practice Address - Fax:937-433-1577
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-06
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36.001778213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0170729Medicaid
OH9251313Medicare PIN