Provider Demographics
NPI:1235164526
Name:DICKSON, EFRAIN OSCAR (MD)
Entity Type:Individual
Prefix:DR
First Name:EFRAIN
Middle Name:OSCAR
Last Name:DICKSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2202 MORGAN AVE
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78405-1909
Mailing Address - Country:US
Mailing Address - Phone:361-884-3966
Mailing Address - Fax:361-884-1842
Practice Address - Street 1:2202 MORGAN AVE
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78405-1909
Practice Address - Country:US
Practice Address - Phone:361-884-3966
Practice Address - Fax:361-884-1842
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2019-10-17
Deactivation Date:2019-08-12
Deactivation Code:
Reactivation Date:2019-10-17
Provider Licenses
StateLicense IDTaxonomies
TXG6800207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG6800OtherLICENSE NUMBER
TX115219101Medicaid
TXG6800OtherLICENSE NUMBER
TX00JU14Medicare UPIN