Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 57.010466 | OH |
Y | 207X00000X | Orthopaedic Surgeon | P1746 | TX |
N | 207XS0117X | Orthopaedic Spine Surgeon | P1746 | TX |
NPI | 1093918245 |
---|---|
Provider Name | Douglas Darko Dickson |
First Address | Fort Worth, TX 76199-0335 |
Second Address | Fort Worth, TX 76107-2553 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2007 |
Last Update Date | 08/07/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
296488401 | (05) | TX |
8DF513 | BCBS (01) | TX |
P01170938 | RAILROAD MEDICARE (01) | TX |