Individual
DR. LARRY J DICKINSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
100 E JOHNSON ST, GALLATIN, MO 64640-1338
(660) 663-2800
(660) 663-3707
Mailing address
100 E JOHNSON ST, PO BOX 98, GALLATIN, MO 64640-1338
(660) 663-2800
(660) 663-3707
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
R7052
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
240880708
—
MO
Enumeration date
01/17/2006
Last updated
11/20/2009
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