MEDICARE: DR. DIANA LYNN DICKENS MD

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
1	207K00000X	Allergy & Immunology Physician	H5231	TX

General Provider Information

NPI Number	:	1982604294
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DIANA LYNN DICKENS MD

Provider Business Mailing Address
First Line	:	950 THREADNEEDLE ST
Second Line	:	SUITE 160
City	:	HOUSTON
State	:	TX
Zip	:	77079-2925
Country	:	US
Telephone Number	:	832-379-8200
Fax Number	:	832-379-8201

Provider Business Practice Location Address
First Line	:	950 THREADNEEDLE ST
Second Line	:	SUITE 160
City	:	HOUSTON
State	:	TX
Zip	:	77079-2925
Country	:	US
Telephone Number	:	832-379-8200
Fax Number	:	832-379-8201

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/28/2005
Last Update Date	:	04/16/2014

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