Provider Demographics
NPI:1114960333
Name:DICKEY, RUSSELL ALLISON (MD)
Entity Type:Individual
Prefix:
First Name:RUSSELL
Middle Name:ALLISON
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 1:811 W INTERSTATE 20 STE 218
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76017-5873
Mailing Address - Country:US
Mailing Address - Phone:817-277-7133
Mailing Address - Fax:817-274-6367
Practice Address - Street 1:811 W INTERSTATE 20 STE 218
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76017-5873
Practice Address - Country:US
Practice Address - Phone:817-277-7133
Practice Address - Fax:817-274-6367
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH2339207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX101559603Medicaid
TX101559602Medicaid
TX101559603Medicaid
TX101559602Medicaid
TX101559603Medicaid