Provider Demographics
NPI:1083693907
Name:CHRISTIAN M DICKSON, DPM, PA
Entity Type:Organization
Organization Name:CHRISTIAN M DICKSON, DPM, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DICKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-993-4230
Mailing Address - Street 1:5920 SARATOGA BLVD
Mailing Address - Street 2:SUITE 600 B
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78414-4104
Mailing Address - Country:US
Mailing Address - Phone:361-993-4230
Mailing Address - Fax:361-993-5680
Practice Address - Street 1:5920 SARATOGA BLVD
Practice Address - Street 2:SUITE 600 B
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78414-4104
Practice Address - Country:US
Practice Address - Phone:361-993-4230
Practice Address - Fax:361-993-5680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-10
Last Update Date:2008-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1463213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX181572201Medicaid
TX5792580001Medicare NSC
TX00W627Medicare ID - Type Unspecified
TXU76547Medicare UPIN