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General NPI Number Information
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NPI Number | 1720720717
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Entity Type | Individual
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Provider Name | DEVON WEIDNER DICKEY MD
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Gender | Female
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Dates
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Enumeration Date | 04/10/2022
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Last Update Date | 04/10/2022
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Provider Practice Location Address
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Address Line | 6431 FANNIN ST RM 5.170
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City | HOUSTON
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State | TX
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Zip | 77030-1501
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Country | US
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Telephone | 713-500-7160
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Fax | 713-500-0648
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Provider Business Mailing Address
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Address Line | 404 S FRYERS CREEK CIR APT 1107
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City | TEMPLE
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State | TX
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Zip | 76504-7584
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Country | US
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Telephone | 214-502-5541
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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