Provider Demographics
NPI:1932143344
Name:DICKSON, ILANA F (MD)
Entity Type:Individual
Prefix:DR
First Name:ILANA
Middle Name:F
Last Name:DICKSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:777 NW 9TH ST
Mailing Address - Street 2:SUITE 320
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-6169
Mailing Address - Country:US
Mailing Address - Phone:541-768-4900
Mailing Address - Fax:541-768-4901
Practice Address - Street 1:777 NW 9TH ST
Practice Address - Street 2:SUITE 320
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-6169
Practice Address - Country:US
Practice Address - Phone:541-768-4900
Practice Address - Fax:541-768-4901
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2016-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD24713208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR169822Medicare UPIN