Provider Demographics
NPI:1134111933
Name:DICKEY, ROBERT ALLAN (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:ALLAN
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 1:2801 PARKLAWN DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73110-4211
Mailing Address - Country:US
Mailing Address - Phone:405-737-6691
Mailing Address - Fax:405-737-7723
Practice Address - Street 1:2801 PARKLAWN DR
Practice Address - Street 2:SUITE 101
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73110-4211
Practice Address - Country:US
Practice Address - Phone:405-737-6691
Practice Address - Fax:405-737-7723
Is Sole Proprietor?:No
Enumeration Date:2005-08-17
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK8851207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100738060AMedicaid
OK44604663002OtherBLUE CROSS BLUE SHIELD
OK44604663002OtherBLUE CROSS BLUE SHIELD