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General NPI Number Information
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NPI Number | 1912210576
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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 | 07/23/2010
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Last Update Date | 10/05/2011
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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 | 75090-1796
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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 | 75090-1796
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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 E 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 | H6165
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License Number State | TX
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