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Individual
DR. CHARLES WAYNE DICKERSON
Active
Individual
DR. CHARLES WAYNE DICKERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
14590
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
731260610001
BCBS
—
Enumeration date
07/06/2006
Last updated
09/13/2011
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