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NPI Code Detail

MEDICARE: DR. EDWARD LEWIS DICK M.D.

MEDICARE:  DR. EDWARD LEWIS DICK  M.D.
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
1207Q00000XFamily Medicine PhysicianL3281TX
2207Q00000XFamily Medicine Physician18994OK
3208000000XPediatrics PhysicianL3281TX

General Provider Information

NPI Number : 1700919578
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. EDWARD LEWIS DICK M.D.
Provider Business Mailing Address
First Line : 1406 FITCH ST
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78211-1406
Country : US
Telephone Number : 210-922-6922
Fax Number :
Provider Business Practice Location Address
First Line : 1406 FITCH ST
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78211-1406
Country : US
Telephone Number : 210-922-6922
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/13/2007
Last Update Date : 07/24/2009

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Directions to “ DR. EDWARD LEWIS DICK M.D.” Practice Location

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