Provider Demographics
NPI:1942302997
Name:DICKSON, KYLE F (MD, MBA)
Entity Type:Individual
Prefix:DR
First Name:KYLE
Middle Name:F
Last Name:DICKSON
Suffix:
Gender:M
Credentials:MD, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6560 FANNIN ST
Mailing Address - Street 2:SUITE 1016
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2761
Mailing Address - Country:US
Mailing Address - Phone:713-800-1080
Mailing Address - Fax:713-800-1081
Practice Address - Street 1:6560 FANNIN ST
Practice Address - Street 2:SUITE 1016
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2761
Practice Address - Country:US
Practice Address - Phone:713-800-1080
Practice Address - Fax:713-800-1081
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN0733207XX0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0801XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Trauma
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1843351-03Medicaid
TXTXB122482Medicare PIN
TXTXB122488Medicare PIN