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NPI Code Detail

MEDICARE: FORRESTINE DICKSON KNOWLES M.D.

MEDICARE: FORRESTINE DICKSON KNOWLES 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
12084P0804XChild & Adolescent Psychiatry PhysicianS1629TX
22084P0800XPsychiatry PhysicianS1629TX

General Provider Information

NPI Number : 1932588415
Entity Type Code : Individual
Provider Name (Legal Business Name) : FORRESTINE DICKSON KNOWLES M.D.
Provider Business Mailing Address
First Line : 2535 CORDES DR
Second Line :
City : SUGAR LAND
State : TX
Zip : 77479-1386
Country : US
Telephone Number : 281-276-4400
Fax Number :
Provider Business Practice Location Address
First Line : 2535 CORDES DR
Second Line :
City : SUGAR LAND
State : TX
Zip : 77479-1386
Country : US
Telephone Number : 281-276-4400
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/29/2015
Last Update Date : 02/01/2022

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