Basic Information
| Provider Information | |||||||||
| NPI: | 1194252460 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DICKSON | ||||||||
| FirstName: | MICHAEL | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1200 MOUNTAIN ST STE 230 | ||||||||
| Address2: | |||||||||
| City: | CARSON CITY | ||||||||
| State: | NV | ||||||||
| PostalCode: | 897033867 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7758852229 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1475 MEDICAL PKWY | ||||||||
| Address2: | |||||||||
| City: | CARSON CITY | ||||||||
| State: | NV | ||||||||
| PostalCode: | 897034635 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7758852229 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/17/2017 | ||||||||
| LastUpdateDate: | 08/27/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/27/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | FD0261949-1323 | TX | N | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | 20174 | NV | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.