Provider Demographics
NPI:1407863939
Name:DICKEY, STEPHEN HOWARD (DO)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:HOWARD
Last Name:DICKEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 108
Mailing Address - Street 2:
Mailing Address - City:DE LEON
Mailing Address - State:TX
Mailing Address - Zip Code:76444
Mailing Address - Country:US
Mailing Address - Phone:254-879-4910
Mailing Address - Fax:254-879-4991
Practice Address - Street 1:10201 HIGHWAY 16
Practice Address - Street 2:
Practice Address - City:COMANCHE
Practice Address - State:TX
Practice Address - Zip Code:76442-4462
Practice Address - Country:US
Practice Address - Phone:254-879-4910
Practice Address - Fax:254-879-4991
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK1416207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG33395Medicare UPIN
TX8F2240Medicare PIN