Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 583423 | TX |
N | 111NI0900X | Internist | 583423 | TX |
N | 207RC0000X | Internist - Cardiovascular Disease | 04-43656 | KS |
Y | 207RC0000X | Internist - Cardiovascular Disease | 2020027326 | MO |
N | 207RC0000X | Internist - Cardiovascular Disease | A149358 | CA |
NPI | 1023422474 |
---|---|
Provider Name | Stephen Dickson |
First Address | Independence, MO 64057-2326 |
Second Address | Independence, MO 64057-2326 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2014 |
Last Update Date | 08/09/2020 |