Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | H7288 | TX |
NPI | 1043250533 |
---|---|
Provider Name | Dr. Charles T Dickson |
First Address | Tyler, TX 75701-1951 |
Second Address | Tyler, TX 75701-1951 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2006 |
Last Update Date | 14/08/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
125213201 | (05) | TX |
F76825 | (02) | TX |