Individual
CHASE WILLIAM DICKERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
108 W MAIN ST, TISHOMINGO, OK 73460-1723
(580) 371-3019
Mailing address
108 W MAIN ST, TISHOMINGO, OK 73460-1723
(580) 371-3019
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
12/13/2022
Last updated
12/13/2022
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