Provider Demographics
NPI:1851603047
Name:DICKEY, LOUIS S (MD)
Entity Type:Individual
Prefix:
First Name:LOUIS
Middle Name:S
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 1:1607 BARROLO CT
Mailing Address - Street 2:
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75032-7534
Mailing Address - Country:US
Mailing Address - Phone:860-803-7535
Mailing Address - Fax:214-545-5331
Practice Address - Street 1:1607 BARROLO CT
Practice Address - Street 2:
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75032
Practice Address - Country:US
Practice Address - Phone:860-803-7535
Practice Address - Fax:214-545-5331
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-05
Last Update Date:2018-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE8434207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK88929Medicare UPIN