Provider Demographics
NPI:1306823463
Name:DICKINSON, ROBERT BENJAMIN (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:BENJAMIN
Last Name:DICKINSON
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 1:8240 N MOPAC EXPY STE 100
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-8869
Mailing Address - Country:US
Mailing Address - Phone:512-687-1950
Mailing Address - Fax:
Practice Address - Street 1:1180 SETON PKWY STE 125
Practice Address - Street 2:
Practice Address - City:KYLE
Practice Address - State:TX
Practice Address - Zip Code:78640-4076
Practice Address - Country:US
Practice Address - Phone:512-268-7100
Practice Address - Fax:512-268-7200
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL9176208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1699159-04Medicaid
TX169915901Medicaid
TX8CN495OtherBCBS
TX8CN495OtherBCBS
I19468Medicare UPIN
TX1699159-04Medicaid
TX611061Medicare ID - Type Unspecified