Provider Demographics
NPI:1205832433
Name:DICKMAN, DONALD G (MD)
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:G
Last Name:DICKMAN
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 1:4674 SNOW MESA DR
Mailing Address - Street 2:SUITE 140
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80528
Mailing Address - Country:US
Mailing Address - Phone:970-225-5000
Mailing Address - Fax:
Practice Address - Street 1:9251 TWENTY MILE ROAD
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80134
Practice Address - Country:US
Practice Address - Phone:970-225-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2020-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0034346207Q00000X
IA32030207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1205832433Medicaid
IA080114694OtherRAILROAD MEDICARE
IA1157081Medicaid
IA40692OtherBLUE SHIELD OF IOWA
IAI20327Medicare PIN
IA40692Medicare ID - Type Unspecified
IA1205832433Medicaid