Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | L9175 | TX |
Y | 2080P0202X | Pediatric Cardiologist | L9175 | TX |
NPI | 1184660284 |
---|---|
Provider Name | Ms. Heather Anne Dickerson |
First Address | Houston, TX 77030-2303 |
Second Address | Houston, TX 77030-2303 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2006 |
Last Update Date | 28/04/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I11931 | (02) | TX |