Charles Wayne Dickerson, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

14590 Issued in OK

Practice address

1601 Brookwood Ave
Duncan, OK 73533-1360

Phone

(580) 252-3232

Fax

(580) 252-4893

NPI assigned

Jul 6, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in OK

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Duncan Regional Hospital, Inc

  • Multi-Specialty Clinic/Center
  • Duncan, OK
  • NPI 1942918214

  Family Medicine

  NPD (past)
• Solutions Practice Management

  • Family Medicine Physician
  • Duncan, OK
  • NPI 1104009299

  Family Medicine

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152144000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1315872000000",
    "number": "1962433748",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1601 BROOKWOOD AVE",
            "city": "DUNCAN",
            "state": "OK",
            "postal_code": "735331360",
            "telephone_number": "580-252-3232",
            "fax_number": "580-252-4893"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1601 BROOKWOOD AVE",
            "city": "DUNCAN",
            "state": "OK",
            "postal_code": "735331360",
            "telephone_number": "580-252-3232",
            "fax_number": "580-252-4893"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DICKERSON",
        "first_name": "CHARLES",
        "middle_name": "WAYNE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-06",
        "last_updated": "2011-09-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OK",
            "license": "14590",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "731260610001",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Dorothy Susan Denard, M. S., L.P.C.
• Dennis F. Hughes, M.D.
• Linda Irene Dennis, LPC NCC ATR BC
• Sammie Lea Denson, LMFT
• Erica Gean Dewoody
• Elizabeth Disalvatore, MHS, PA-C
• Aiga Dissmann
• Michael Anthony Ditmore
• Hunter Dixon
• Kelby Doucet-Maddox

• All providers in Duncan, OK
• Family Medicine Physician in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.