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General NPI Number Information
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NPI Number | 1093918245
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Entity Type | Individual
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Provider Name | DOUGLAS DARKO DICKSON MD
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Gender | Male
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Dates
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Enumeration Date | 06/06/2007
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Last Update Date | 07/08/2013
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Provider Practice Location Address
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Address Line | 855 MONTGOMERY ST
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City | FORT WORTH
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State | TX
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Zip | 76107-2553
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Country | US
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Telephone | 817-735-2900
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 99335
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City | FORT WORTH
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State | TX
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Zip | 76199-0335
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Country | US
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Telephone | 817-735-2900
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 57.010466
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | P1746
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 207XS0117X
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Taxonomy Name | Orthopaedic Surgery of the Spine Physician
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License Number | P1746
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License Number State | TX
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