Provider Demographics
NPI:1851349773
Name:DICKHAUT, STEVEN CHARLES (MD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:CHARLES
Last Name:DICKHAUT
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 1:4800 N.E. STALLINGS
Mailing Address - Street 2:SUITE 110
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75965
Mailing Address - Country:US
Mailing Address - Phone:936-569-9443
Mailing Address - Fax:936-560-5667
Practice Address - Street 1:4800 NE STALLINGS DR
Practice Address - Street 2:SUITE 110
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75965-1249
Practice Address - Country:US
Practice Address - Phone:936-569-9443
Practice Address - Fax:936-560-5667
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE8435174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX751912628OtherTAX I.D.
TX0896557-02Medicaid
TX751912628OtherTAX I.D.
TX00TV87Medicare PIN
TX0896557-02Medicaid