Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | J4085 | TX |
Y | 207XS0106X | Orthopaedic Hand Surgeon | J4085 | TX |
NPI | 1114975950 |
---|---|
Provider Name | Dr. Kent Farr Dickson |
First Address | Flower Mound, TX 75028-2783 |
Second Address | Flower Mound, TX 75028 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2006 |
Last Update Date | 01/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
029379702 | (05) | TX |
200031203 | RAILROAD MEDICARE (01) | TX |
8BF132 | BLUECROSS (01) | TX |
G64966 | (02) | TX |