Provider Demographics
NPI:1649597691
Name:THOMAS LANE DYKES, JR., M.D., P.A.
Entity Type:Organization
Organization Name:THOMAS LANE DYKES, JR., M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:LANE
Authorized Official - Last Name:DYKES
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD, PA
Authorized Official - Phone:972-298-4981
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-30
Last Update Date:2010-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF9386207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty