MEDICARE: SANDRA DICKERSON MD PA

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	208600000X	Surgery Physician

General Provider Information

NPI Number	:	1578709390
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SANDRA DICKERSON MD PA

Provider Business Mailing Address
First Line	:	PO BOX 65348
Second Line	:
City	:	LUBBOCK
State	:	TX
Zip	:	79464-5348
Country	:	US
Telephone Number	:	806-771-3950
Fax Number	:	806-771-4029

Provider Business Practice Location Address
First Line	:	5004 FRANKFORD AVE
Second Line	:	SUITE 400
City	:	LUBBOCK
State	:	TX
Zip	:	79424-1131
Country	:	US
Telephone Number	:	806-771-3950
Fax Number	:	806-771-4029

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. SANDRA DEE DICKERSON
Credential	:	MD
Telephone Number	:	806-771-3950

Provider Enumeration Date	:	12/29/2008
Last Update Date	:	03/26/2009

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