MEDICARE: MARSHALL J DYKE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	D1619	TX

General Provider Information

NPI Number	:	1518137330
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARSHALL J DYKE

Provider Business Mailing Address
First Line	:	15000 MANSIONS VIEW DR APT 702
Second Line	:
City	:	CONROE
State	:	TX
Zip	:	77384-4343
Country	:	US
Telephone Number	:	936-232-0440
Fax Number	:

Provider Business Practice Location Address
First Line	:	8333 BEECHNUT ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77036-6853
Country	:	US
Telephone Number	:	713-776-9904
Fax Number	:	713-776-9946

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/07/2008
Last Update Date	:	01/11/2026

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