Individual
DR. CHARLES WAYNE DICKERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1601 BROOKWOOD AVE, DUNCAN, OK 73533-1360
(580) 252-3232
(580) 252-4893
Mailing address
1601 BROOKWOOD AVE, DUNCAN, OK 73533-1360
(580) 252-3232
(580) 252-4893
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
14590
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
731260610001
BCBS
—
Enumeration date
07/06/2006
Last updated
09/13/2011
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