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General NPI Number Information
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NPI Number | 1083735682
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Entity Type | Organization
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Legal Business Name | RANDALL M DICK MD PA
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Dates
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Enumeration Date | 04/02/2007
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Last Update Date | 04/18/2008
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Provider Practice Location Address
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Address Line | 2101 PLANTATION LN
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City | PLANO
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State | TX
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Zip | 75093-4220
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Country | US
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Telephone | 972-202-3425
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Fax | 972-202-3423
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Provider Business Mailing Address
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Address Line | PO BOX 848775
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City | BOSTON
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State | MA
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Zip | 02284-8775
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Country | US
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Telephone | 972-202-3425
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Fax | 972-202-3423
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RANDALL M DICK
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Credential | MD
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Telephone | 972-202-3425
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | H8624
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License Number State | TX
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