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NPI Code Detail

MEDICARE: MRS. ROBIN MICHELLE DICKERSON R.T.(R)(T)

MEDICARE: MRS. ROBIN MICHELLE DICKERSON R.T.(R)(T)
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12471R0002XRadiation Therapy Radiologic Technologist92682TX

General Provider Information

NPI Number : 1316231152
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. ROBIN MICHELLE DICKERSON R.T.(R)(T)
Provider Business Mailing Address
First Line : 5206 AVENUE P
Second Line :
City : SANTA FE
State : TX
Zip : 77510-9234
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2002 HOLCOMBE BLVD
Second Line :
City : HOUSTON
State : TX
Zip : 77030-4211
Country : US
Telephone Number : 713-794-7190
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/08/2011
Last Update Date : 06/08/2011

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