Healthcare Provider Details

I. General information

NPI: 1497440333
Provider Name (Legal Business Name): ANTHONY DYKES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2023
Last Update Date: 04/06/2023
Certification Date: 04/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 N ROBINSON DR
ROBINSON TX
76706-5312
US

IV. Provider business mailing address

620 N ROBINSON DR
ROBINSON TX
76706-5312
US

V. Phone/Fax

Practice location:
  • Phone: 254-732-2262
  • Fax: 254-732-2263
Mailing address:
  • Phone: 254-732-2262
  • Fax: 254-732-2263

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: