Provider Demographics
NPI:1467505404
Name:DICKERSON PEDIATRICS, P.A.
Entity type:Organization
Organization Name:DICKERSON PEDIATRICS, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE COMMITTEE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:CASSANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:DICKERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:832-643-7047
Mailing Address - Street 1:PO BOX 16985
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77496-6985
Mailing Address - Country:US
Mailing Address - Phone:281-491-5439
Mailing Address - Fax:281-240-0577
Practice Address - Street 1:4760 SWEETWATER BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-3148
Practice Address - Country:US
Practice Address - Phone:281-491-5439
Practice Address - Fax:281-240-0577
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK7434208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty