Provider Demographics
NPI:1861599508
Name:DICKEY, VIRGIL ANDREW JR (N/A)
Entity type:Individual
Prefix:
First Name:VIRGIL
Middle Name:ANDREW
Last Name:DICKEY
Suffix:JR
Gender:M
Credentials:N/A
Other - Prefix:
Other - First Name:BUD
Other - Middle Name:ANDREW
Other - Last Name:DICKEY
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:N/A
Mailing Address - Street 1:2400 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97404-2042
Mailing Address - Country:US
Mailing Address - Phone:541-345-5395
Mailing Address - Fax:541-345-7360
Practice Address - Street 1:2400 RIVER RD
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97404-2042
Practice Address - Country:US
Practice Address - Phone:541-345-5395
Practice Address - Fax:541-345-7360
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist