Provider Demographics
NPI:1588640148
Name:DICKERSON, CRISTIN A (MD)
Entity Type:Individual
Prefix:MS
First Name:CRISTIN
Middle Name:A
Last Name:DICKERSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 ALBANS RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77005-1643
Mailing Address - Country:US
Mailing Address - Phone:832-914-4552
Mailing Address - Fax:866-653-0882
Practice Address - Street 1:2020 ALBANS RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77005-1643
Practice Address - Country:US
Practice Address - Phone:832-914-4552
Practice Address - Fax:866-653-0882
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2014-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH79982085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1972539492OtherTYPE 2 NPI - GROUP
TX8CG385OtherBCBSTX
TX325936Medicare PIN
TX1972539492OtherTYPE 2 NPI - GROUP