Provider Demographics
NPI:1942370960
Name:ROB DICKERMAN DO PHD PA
Entity Type:Organization
Organization Name:ROB DICKERMAN DO PHD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NEUROSURGEON
Authorized Official - Prefix:
Authorized Official - First Name:ROB
Authorized Official - Middle Name:
Authorized Official - Last Name:DICKERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:972-238-0512
Mailing Address - Street 1:6200 W PARKER RD
Mailing Address - Street 2:MOB1-503
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-7939
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5575 FRISCO SQUARE BLVD STE 110
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-3309
Practice Address - Country:US
Practice Address - Phone:972-238-0512
Practice Address - Fax:972-378-6925
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00X058Medicare PIN
TXI11394Medicare UPIN