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General NPI Number Information
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NPI Number | 1497944573
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Entity Type | Organization
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Legal Business Name | GERALD LEWIS DICKMAN, D.O., PLLC
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Dates
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Enumeration Date | 10/15/2007
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Last Update Date | 10/17/2007
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Provider Practice Location Address
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Address Line | 3400 NW EXPRESSWAY BUILDING C, SUITE 604
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City | OKLAHOMA CITY
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State | OK
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Zip | 73112-4493
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Country | US
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Telephone | 405-945-4828
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Fax | 405-945-4831
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Provider Business Mailing Address
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Address Line | 3400 NW EXPRESSWAY BUILDING C, SUITE 604
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City | OKLAHOMA CITY
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State | OK
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Zip | 73112-4493
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Country | US
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Telephone | 405-945-4828
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Fax | 405-945-4831
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. GERALD LEWIS DICKMAN
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Credential |
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Telephone | 405-945-4828
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 1726
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License Number State | OK
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