Individual
DR. OTTO FREDERICK DICKMAN IV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
90 WEST MAIN, EMERY MEDICAL CENTER, CASTLE DALE, UT 84513-0607
(435) 381-2305
(435) 381-4535
Mailing address
PO BOX 607, EMERY MEDICAL CENTER, CASTLE DALE, UT 84513-0607
(435) 381-2305
(435) 381-4535
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
495-6304-1205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
621762357076
—
UT
05
—
621762357080
—
UT
Enumeration date
10/11/2006
Last updated
07/09/2007
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