1851582092 NPI number — DR. DONOVAN D DIXON M.D.,

Table of content: DR. DONOVAN D DIXON M.D., (NPI 1851582092)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851582092 NPI number — DR. DONOVAN D DIXON M.D.,

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DIXON
Provider First Name:
DONOVAN
Provider Middle Name:
D
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.,
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1851582092
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/20/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3771 RAMSEY STREET
Provider Second Line Business Mailing Address:
SUITE 109-237
Provider Business Mailing Address City Name:
FAYETTEVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28311-7675
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
347-452-9437
Provider Business Mailing Address Fax Number:
910-488-7770

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
812 CANDY PARK ROAD 5101
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PEMBROKE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28372-7322
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-522-1143
Provider Business Practice Location Address Fax Number:
910-522-1162
Provider Enumeration Date:
08/05/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  237457 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207V00000X , with the licence number: 201001347 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 5916910 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com