Provider Demographics
NPI:1932526860
Name:DICKEY, BENJAMIN W (MD, MPH)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:W
Last Name:DICKEY
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:BENJAMIN
Other - Middle Name:
Other - Last Name:DICKEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2323 BETHARDS DR
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95405-8500
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:714-937-6233
Practice Address - Street 1:2323 BETHARDS DR
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95405-8500
Practice Address - Country:US
Practice Address - Phone:707-542-1611
Practice Address - Fax:707-542-9958
Is Sole Proprietor?:No
Enumeration Date:2014-03-28
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAA149307207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program