Provider Demographics
NPI:1083735682
Name:RANDALL M DICK MD PA
Entity Type:Organization
Organization Name:RANDALL M DICK MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:M
Authorized Official - Last Name:DICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-202-3425
Mailing Address - Street 1:PO BOX 848775
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02284-8775
Mailing Address - Country:US
Mailing Address - Phone:972-202-3425
Mailing Address - Fax:972-202-3423
Practice Address - Street 1:2101 PLANTATION LN
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-4220
Practice Address - Country:US
Practice Address - Phone:972-202-3425
Practice Address - Fax:972-202-3423
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH8624207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXE88133Medicare UPIN
TX00G02XMedicare PIN