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Individual

DIANE M VICKERY

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
230 MEDICAL CENTER DR, C/O ACRMC OUTPATIENT CLINIC, SEAMAN, OH 45679-8002
(937) 386-3420
(937) 386-3439
Mailing address
230 MEDICAL CENTER DR, C/O ACRMC OUTPATIENT CLINIC, SEAMAN, OH 45679-8002
(937) 386-3420
(937) 386-3439

Taxonomy

Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
35-04-3357
OH

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0460826
OH
Enumeration date
05/11/2006
Last updated
03/31/2010
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