Provider Demographics
NPI:1033930813
Name:MARK H. DICKIE, MD PLLC
Entity type:Organization
Organization Name:MARK H. DICKIE, MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:DICKIE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:254-870-4417
Mailing Address - Street 1:782 DRY CREEK RD
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76705-5409
Mailing Address - Country:US
Mailing Address - Phone:254-870-4417
Mailing Address - Fax:254-230-4493
Practice Address - Street 1:782 DRY CREEK RD
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76705-5409
Practice Address - Country:US
Practice Address - Phone:254-870-4417
Practice Address - Fax:254-230-4493
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-23
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty