Organization
CHARLES H. DICKERSON
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CHARLES H DICKERSON RADIOLOGIC TECHNOLOG (OWNER)
(903) 596-9729
Entity
Organization
Contact information
Practice address
2208 OLD HENDERSON HWY, TYLER, TX 75702-6457
(903) 596-9729
(903) 596-7206
Mailing address
PO BOX 9700, TYLER, TX 75711-2700
(903) 596-9729
(903) 596-7206
Taxonomy
Speciality
Code
Description
License number
State
261QR0208X
Mobile Radiology Clinic/Center
Primary
6309
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0860918 01
—
TX
Enumeration date
07/14/2006
Last updated
06/30/2014
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