Provider Demographics
NPI:1861475956
Name:DICKERSON, KAREN DELANE (MD)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:DELANE
Last Name:DICKERSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1675 REPUBLIC PKWY
Mailing Address - Street 2:STE 201
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-6902
Mailing Address - Country:US
Mailing Address - Phone:972-850-9179
Mailing Address - Fax:877-720-5614
Practice Address - Street 1:1675 REPUBLIC PKWY
Practice Address - Street 2:STE 201
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-6902
Practice Address - Country:US
Practice Address - Phone:972-672-8484
Practice Address - Fax:972-692-8227
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-22
Last Update Date:2021-03-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXJ4083174400000X, 2081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXF68321Medicare UPIN