Basic Information
Provider Information | |||||||||
NPI: | 1609849272 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | DIXON | ||||||||
FirstName: | JAMES | ||||||||
MiddleName: | GRAYSON | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 936 | ||||||||
Address2: |   | ||||||||
City: | NORFOLK | ||||||||
State: | VA | ||||||||
PostalCode: | 235010936 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7574465955 | ||||||||
FaxNumber: | 7574465196 | ||||||||
Practice Location | |||||||||
Address1: | 825 FAIRFAX AVE | ||||||||
Address2: |   | ||||||||
City: | NORFOLK | ||||||||
State: | VA | ||||||||
PostalCode: | 235071914 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7574465955 | ||||||||
FaxNumber: | 7574465196 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 02/13/2006 | ||||||||
LastUpdateDate: | 11/25/2009 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 01010343661 | VA | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine |   | 207QG0300X | 0101034661 | VA | N |   | Allopathic & Osteopathic Physicians | Family Medicine | Geriatric Medicine | 207Q00000X | 0101034661 | VA | N |   | Allopathic & Osteopathic Physicians | Family Medicine |   |
ID Information
ID | Type | State | Issuer | Description | 006026001 | 05 | VA |   | MEDICAID | 227456 | 01 | VA | UHC/MAMSI | OTHER | 890516K | 05 | NC |   | MEDICAID | 0516K | 01 | NC | BC/BS | OTHER | PAR | 01 | VA | FIRST HEALTH COMMERCIAL/SOUTHERN HEALTH/COVENTRY | OTHER | 332674 | 01 | VA | ANTHEM | OTHER | PAR | 01 | VA | CIGNA | OTHER | PAR | 01 | VA | VA HEALTH NETWORK | OTHER | PAR | 01 | VA | MULTIPLAN | OTHER | PAR | 01 | VA | USA MANAGED CARE | OTHER | 12095 | 01 | VA | SENTARA OPTIMA | OTHER | PAR | 01 | VA | VIRGINIA PREMIER HEALTH | OTHER | PAR | 01 | VA | CORVEL/CORCARE | OTHER | -002 -003 | 01 | VA | TRICARE/CHAMPUS | OTHER | 005612829 | 05 | VA |   | MEDICAID | PAR | 01 | VA | AETNA | OTHER |