Provider Demographics
NPI:1528034196
Name:DYKES, THOMAS LANE (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:LANE
Last Name:DYKES
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 1:777 E WHEATLAND RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:DUNCANVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75116-4918
Mailing Address - Country:US
Mailing Address - Phone:972-298-4981
Mailing Address - Fax:972-298-4984
Practice Address - Street 1:777 E WHEATLAND RD
Practice Address - Street 2:SUITE 102
Practice Address - City:DUNCANVILLE
Practice Address - State:TX
Practice Address - Zip Code:75116-4918
Practice Address - Country:US
Practice Address - Phone:972-298-4981
Practice Address - Fax:972-298-4984
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2010-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF9386173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8G1659Medicare ID - Type Unspecified
TX033929302Medicare ID - Type Unspecified
TXB22426Medicare UPIN