Dickerson, Charles H

Dickerson, Charles H is an sole proprietor health care provider with primary practice located at 2208 Old Henderson Hwy , Tyler TX 75702-6457. He recently has only one registered license in Technologists, Technicians & Other Technical Service Providers / Radiologic Technologist, which is considered as his primary health care specialty. Dickerson, Charles H can be contacted via phone (903) 596-9729.

Contact Information

Primary practice address
2208 Old Henderson Hwy Tyler TX 75702-6457
Phone: (903) 596-9729
Fax: (903) 747-3373
Website:
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Health care specialties

SpecialtyCodeLicense #State
Technologists, Technicians & Other Technical Service Providers / Radiologic Technologist 247100000X 6309 Texas

Profile Details

NPI number 1699181842
LBN Legal business name Dickerson, Charles H
Credentials
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jul 9th, 2014
Last updated Jul 9th, 2014 - about 10 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1699181842 NPPES
Texas MEDICAID 0860918-01

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