Provider Demographics
NPI:1982604294
Name:DICKENS, DIANA LYNN (MD)
Entity Type:Individual
Prefix:DR
First Name:DIANA
Middle Name:LYNN
Last Name:DICKENS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 THREADNEEDLE ST
Mailing Address - Street 2:SUITE 160
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77079-2925
Mailing Address - Country:US
Mailing Address - Phone:832-379-8200
Mailing Address - Fax:832-379-8201
Practice Address - Street 1:950 THREADNEEDLE ST
Practice Address - Street 2:SUITE 160
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77079-2925
Practice Address - Country:US
Practice Address - Phone:832-379-8200
Practice Address - Fax:832-379-8201
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2014-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH5231207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
F79753Medicare UPIN
TX84T574Medicare ID - Type Unspecified