Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 35.061901 | OH |
N | 207QA0401X | Family Doctor - Addiction Medicine | 35061901 | OH |
NPI | 1568401685 |
---|---|
Provider Name | Duane Dickens |
First Address | Trotwood, OH 45426-2640 |
Second Address | Trotwood, OH 45426-2640 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2006 |
Last Update Date | 28/12/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0804801 | (05) | OH |
0848015 | (05) | OH |
E76349 | (02) |