Provider Demographics
NPI:1962424747
Name:DICKERMAN, ROB D (DO, PHD)
Entity type:Individual
Prefix:
First Name:ROB
Middle Name:D
Last Name:DICKERMAN
Suffix:
Gender:M
Credentials:DO, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5575 FRISCO SQUARE BLVD STE 110
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-3309
Mailing Address - Country:US
Mailing Address - Phone:972-238-0512
Mailing Address - Fax:972-378-6925
Practice Address - Street 1:5575 FRISCO SQUARE BLVD STE 110
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-3309
Practice Address - Country:US
Practice Address - Phone:972-238-0512
Practice Address - Fax:972-378-6925
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL9174207XS0117X, 207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
No207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00X058OtherMEDICARE GROUP
TX00X058OtherMEDICARE GROUP
TX8F3988Medicare PIN