Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VE0102X | Reproductive Endocrinologist | 03193R | LA |
NPI | 1104826577 |
---|---|
Provider Name | Dr. Richard Dickey |
First Address | Mandeville, LA 70448-4664 |
Second Address | Mandeville, LA 70448-4664 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C67423 | (02) | LA |