Provider Demographics
NPI:1356401707
Name:DICKEY, WILLIAM DARYL (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:DARYL
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 1:2850 LEWIS LN
Mailing Address - Street 2:STE 111
Mailing Address - City:PARIS
Mailing Address - State:TX
Mailing Address - Zip Code:75460-9383
Mailing Address - Country:US
Mailing Address - Phone:903-785-0025
Mailing Address - Fax:903-784-4140
Practice Address - Street 1:2850 LEWIS LN
Practice Address - Street 2:STE 111
Practice Address - City:PARIS
Practice Address - State:TX
Practice Address - Zip Code:75460-9383
Practice Address - Country:US
Practice Address - Phone:903-785-0025
Practice Address - Fax:903-784-4140
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2014-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ2552207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX039347601Medicaid
100002363OtherMEDICARE RAILROAD
TX100143530AOtherSTATE ID
TXD38747Medicare UPIN
100002363OtherMEDICARE RAILROAD