1407806730 NPI number — DR. JOHN E DIXON M.D.

Table of content: DR. JOHN E DIXON M.D. (NPI 1407806730)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407806730 NPI number — DR. JOHN E DIXON M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DIXON
Provider First Name:
JOHN
Provider Middle Name:
E
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:
1407806730
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/14/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1429 3RD ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CAMANCHE
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
52730-2003
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
563-259-8015
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1429 3RD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CAMANCHE
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52730-2003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
563-259-8015
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/10/2006

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:  20089 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 20311 . This is a "WELLMARK BC/BS" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 018411 . This is a "HEALTH ALLIANCE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0188680 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: IA0114 . This is a "JOHN DEERE HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0180373033 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 18988 . This is a "MIDLANDS CHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 27075 . This is a "IOWA HEALTH SOLUTIONS" identifier . This identifiers is of the category "OTHER".




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