Individual
DR. MISTY IRENE DICKERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
7740 WASHINGTON VILLAGE DRIVE, SUITE 100, CENTERVILLE, OH 45458-3994
(937) 531-7900
(937) 531-7901
Mailing address
7740 WASHINGTON VILLAGE DR, SUITE 100, CENTERVILLE, OH 45459-4056
(937) 531-7900
(937) 531-7901
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
34.010654
OH
207V00000X
Obstetrics & Gynecology Physician
Primary
34010654
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0076897
—
OH
Enumeration date
01/30/2009
Last updated
12/04/2020
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