Basic Information
| Provider Information | |||||||||
| NPI: | 1053324368 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NIXON | ||||||||
| FirstName: | NED | ||||||||
| MiddleName: | REED | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2400 EDISON ST | ||||||||
| Address2: | |||||||||
| City: | BRUSH | ||||||||
| State: | CO | ||||||||
| PostalCode: | 807231640 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9708426200 | ||||||||
| FaxNumber: | 9708423572 | ||||||||
| Practice Location | |||||||||
| Address1: | 2400 EDISON ST | ||||||||
| Address2: | |||||||||
| City: | BRUSH | ||||||||
| State: | CO | ||||||||
| PostalCode: | 807231640 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9708426200 | ||||||||
| FaxNumber: | 9708423572 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/15/2006 | ||||||||
| LastUpdateDate: | 11/20/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 38949 | CO | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 47927348 | 05 | CO | MEDICAID |