Provider Demographics
NPI:1578709390
Name:SANDRA DICKERSON MD PA
Entity Type:Organization
Organization Name:SANDRA DICKERSON MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:DEE
Authorized Official - Last Name:DICKERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:806-771-3950
Mailing Address - Street 1:PO BOX 65348
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79464-5348
Mailing Address - Country:US
Mailing Address - Phone:806-771-3950
Mailing Address - Fax:806-771-4029
Practice Address - Street 1:5004 FRANKFORD AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79424-1131
Practice Address - Country:US
Practice Address - Phone:806-771-3950
Practice Address - Fax:806-771-4029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-29
Last Update Date:2009-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty