Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | 1463 | TX |
NPI | 1033142336 |
---|---|
Provider Name | Christian M Dickson |
First Address | Corpus Christi, TX 78414-4118 |
Second Address | Corpus Christi, TX 78414-4118 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/07/2006 |
Last Update Date | 01/10/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
041906103 | (05) | TX |
U76547 | (02) | TX |