Provider Demographics
NPI:1063853950
Name:DICKEY, WILLIAM CLAYTON (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:CLAYTON
Last Name:DICKEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12588 N PINE CONE RD
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80138-8281
Mailing Address - Country:US
Mailing Address - Phone:303-805-0505
Mailing Address - Fax:
Practice Address - Street 1:12588 N PINE CONE RD
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80138-8281
Practice Address - Country:US
Practice Address - Phone:303-805-0505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-09
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO15902207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
COE37817Medicare UPIN