Provider Demographics
NPI:1164744587
Name:DICKSON, MARY M (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:M
Last Name:DICKSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4112 OUTLOOK BLVD
Mailing Address - Street 2:SUITE 37
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81008-1667
Mailing Address - Country:US
Mailing Address - Phone:719-776-4503
Mailing Address - Fax:
Practice Address - Street 1:6011 E WOODMEN RD
Practice Address - Street 2:SUITE 100
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80923-2602
Practice Address - Country:US
Practice Address - Phone:719-571-8888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-26
Last Update Date:2010-02-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO321672083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine