Individual
DR. TERRY MARC DICKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
745 S GARFIELD AVE, SUITE C, TRAVERSE CITY, MI 49686-3479
(231) 932-1250
(231) 932-1266
Mailing address
745 S GARFIELD AVE, SUITE C, TRAVERSE CITY, MI 49686-3479
(231) 932-1250
(231) 932-1266
Taxonomy
Speciality
Code
Description
License number
State
2080P0006X
Developmental - Behavioral Pediatrics Physician
Primary
4301062201
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0280327
BLUE CROSS BLUE SHIELD MI
MI
05
—
104467082
—
MI
Enumeration date
05/09/2007
Last updated
08/27/2013
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