Provider Demographics
NPI:1174645774
Name:STEVEN C. DICKHAUT, M.D.
Entity Type:Organization
Organization Name:STEVEN C. DICKHAUT, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHARMAYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:DICKHAUT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:936-569-9443
Mailing Address - Street 1:4800 NE STALLINGS DR STE 110
Mailing Address - Street 2:
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75965-1250
Mailing Address - Country:US
Mailing Address - Phone:936-569-9443
Mailing Address - Fax:936-560-5667
Practice Address - Street 1:4800 NE STALLINGS DR STE 110
Practice Address - Street 2:
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75965-1250
Practice Address - Country:US
Practice Address - Phone:936-569-9443
Practice Address - Fax:936-560-5667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2010-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE8435174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1851349773OtherMEDICARE
TX0896557-02Medicaid
TX00399YMedicare ID - Type Unspecified
TX0896557-02Medicaid