Provider Demographics
NPI:1205241536
Name:CRISTIN DICKERSON MD PA
Entity type:Organization
Organization Name:CRISTIN DICKERSON MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CRISTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:DICKERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-524-9190
Mailing Address - Street 1:2020 ALBANS RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77005-1643
Mailing Address - Country:US
Mailing Address - Phone:713-524-9190
Mailing Address - Fax:866-653-0882
Practice Address - Street 1:2020 ALBANS RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77005-1643
Practice Address - Country:US
Practice Address - Phone:713-524-9190
Practice Address - Fax:866-653-0882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-25
Last Update Date:2014-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty