Provider Demographics
NPI:1376980979
Name:JOHN DICKSON, MD, PA
Entity Type:Organization
Organization Name:JOHN DICKSON, MD, PA
Other - Org Name:SONTERRA INTERNAL MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:DICKSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-402-3069
Mailing Address - Street 1:PO BOX 65071
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78265-5071
Mailing Address - Country:US
Mailing Address - Phone:210-402-3069
Mailing Address - Fax:210-424-0631
Practice Address - Street 1:325 E SONTERRA BLVD
Practice Address - Street 2:STE 200
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-4054
Practice Address - Country:US
Practice Address - Phone:210-402-3069
Practice Address - Fax:210-424-0631
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-23
Last Update Date:2013-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty