Provider Demographics
NPI:1033142336
Name:DICKSON, CHRISTIAN M (DPM)
Entity Type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:M
Last Name:DICKSON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5920 SARATOGA BLVD STE 510
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78414-4118
Mailing Address - Country:US
Mailing Address - Phone:361-993-4230
Mailing Address - Fax:361-993-5680
Practice Address - Street 1:5920 SARATOGA BLVD STE 510
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78414-4118
Practice Address - Country:US
Practice Address - Phone:361-993-4230
Practice Address - Fax:361-993-5680
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2019-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1463213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX041906103Medicaid
TXU76547Medicare UPIN
TX041906103Medicaid
TX5792580001Medicare NSC