1619405941 NPI number — TARA DAWN DIXON M.D.

Table of content: TARA DAWN DIXON M.D. (NPI 1619405941)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619405941 NPI number — TARA DAWN DIXON M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DIXON
Provider First Name:
TARA
Provider Middle Name:
DAWN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

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:
1619405941
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/26/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
01/03/2018
NPI Reactivation Date:
01/26/2018

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
325 9TH AVENUE, MC BOX 359792
Provider Second Line Business Mailing Address:
KING COUNTY MEDICAL EXAMINERS OFFICE
Provider Business Mailing Address City Name:
SEATTLE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98104
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-731-3232
Provider Business Mailing Address Fax Number:
206-731-8555

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
325 9TH AVE
Provider Second Line Business Practice Location Address:
KING COUNTY MEDICAL EXAMINERS OFFICE
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98104
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-731-3232
Provider Business Practice Location Address Fax Number:
206-731-8555
Provider Enumeration Date:
05/31/2017

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: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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