Provider Demographics
NPI:1639238512
Name:DICKENS, HEIDI HERRON (MD)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:HERRON
Last Name:DICKENS
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 1:901 N STRONG BLVD
Mailing Address - Street 2:
Mailing Address - City:MCALESTER
Mailing Address - State:OK
Mailing Address - Zip Code:74501-4206
Mailing Address - Country:US
Mailing Address - Phone:918-426-0625
Mailing Address - Fax:918-423-0695
Practice Address - Street 1:901 N STRONG BLVD
Practice Address - Street 2:
Practice Address - City:MCALESTER
Practice Address - State:OK
Practice Address - Zip Code:74501-4206
Practice Address - Country:US
Practice Address - Phone:918-426-0625
Practice Address - Fax:918-423-0695
Is Sole Proprietor?:No
Enumeration Date:2006-12-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK21736207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine