Doctor Name: | ALYSSA RAE DICKEY |
NPI Number: | 1750706552 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MD |
License Number: | 28949 |
Business Practice Address: | 2200 Bergquist Dr Ste 1 Whmc/ge-2200 Jbsa Lackland, TX - 782369908 |
Business Phone Number: | 2109168666 |
Business Fax Number: | |
Mailing Address: | 3551 Roger Brooke Dr, SAN ANTONIO |
State: | TX |
Postal Code: | 782344504 |
Phone Number: | 2109196866 |
Fax Number: | |
NPI Enumeration Date: | 03/03/2014 |
NPI Last Update Date: | 04/21/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 28949 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NE |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |