Provider Demographics
NPI:1720083884
Name:DOOLEY, DIXIE ALLEN (DPM)
Entity Type:Individual
Prefix:DR
First Name:DIXIE
Middle Name:ALLEN
Last Name:DOOLEY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7036 CORPORATE WAY
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45459-4237
Mailing Address - Country:US
Mailing Address - Phone:937-253-6448
Mailing Address - Fax:937-253-5971
Practice Address - Street 1:15 SOUTHMOOR CIR NE
Practice Address - Street 2:
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45429-2451
Practice Address - Country:US
Practice Address - Phone:937-293-6896
Practice Address - Fax:937-293-9150
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36001778213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0337237Medicaid
OH0337237Medicaid
0434085Medicare PIN
OH0434086Medicare PIN
OH0434082Medicare PIN