Individual
DOUGLAS DARKO DICKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
855 MONTGOMERY ST, FORT WORTH, TX 76107-2553
(817) 735-2900
Mailing address
PO BOX 99335, FORT WORTH, TX 76199-0335
(817) 735-2900
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
57.010466
OH
207X00000X
Orthopaedic Surgery Physician
Primary
P1746
TX
207XS0117X
Orthopaedic Surgery of the Spine Physician
P1746
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
296488401
—
TX
01
—
8DF513
BCBS
TX
01
—
P01170938
RAILROAD MEDICARE
TX
Enumeration date
06/06/2007
Last updated
07/08/2013
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