1982643359 NPI number — DR. GEOFFREY R DIXON MD

Table of content: DR. GEOFFREY R DIXON MD (NPI 1982643359)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982643359 NPI number — DR. GEOFFREY R DIXON MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DIXON
Provider First Name:
GEOFFREY
Provider Middle Name:
R
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1982643359
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/31/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1200 S YORK RD
Provider Second Line Business Mailing Address:
SUITE 4280
Provider Business Mailing Address City Name:
ELMHURST
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60126-5626
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
331-462-1700
Provider Business Mailing Address Fax Number:
630-758-8881

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1200 S YORK RD
Provider Second Line Business Practice Location Address:
SUITE 4280
Provider Business Practice Location Address City Name:
ELMHURST
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60126-5626
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
331-462-1700
Provider Business Practice Location Address Fax Number:
630-758-8881
Provider Enumeration Date:
06/04/2006

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: 207T00000X , with the licence number:  010564204A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207T00000X , with the licence number: 036109252 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 200371910 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 129164100 . This is a "INDIANA DEPT OF LABOR" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 140008059 . This is a "PALMETTO RR MEDICARE" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 0227992 . This is a "ANTHEM" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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