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General NPI Number Information
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NPI Number | 1366548414
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Entity Type | Organization
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Legal Business Name | MARK E DICKSON MD PA
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Dates
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Enumeration Date | 09/16/2006
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Last Update Date | 03/16/2011
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Provider Practice Location Address
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Address Line | 3305 N CALAIS ST SUITE #100
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City | SHERMAN
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State | TX
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Zip | 75090-3110
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Country | US
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Telephone | 903-957-0016
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Fax | 903-957-0038
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Provider Business Mailing Address
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Address Line | 3305 N CALAIS ST SUITE #100
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City | SHERMAN
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State | TX
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Zip | 75090-3110
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Country | US
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Telephone | 903-957-0016
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Fax | 903-957-0038
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARK EDWARD DICKSON
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Credential | MD
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Telephone | 903-957-0016
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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