Individual
DR. SAMUEL WENDELL DICKERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
700 SCOTT AND WHITE DR, COLLEGE STATION, TX 77845-6441
(979) 207-0100
Mailing address
PO BOX 844658, DALLAS, TX 75284-4658
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
BP1-0022044
TX
207L00000X
Anesthesiology Physician
Primary
M9971
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2790064977
MYUTMB 2790064977-COMMERCIAL NUMBER
—
Enumeration date
06/14/2007
Last updated
07/14/2021
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