Basic Information
| Provider Information | |||||||||
| NPI: | 1659486736 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | W N DIXON MD PA | ||||||||
| LastName: | |||||||||
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| MiddleName: | |||||||||
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| OtherOrganizationName: | WILLIAM N DIXON MD | ||||||||
| OtherOrganizationType: | 5 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 1311 ASTON AVE | ||||||||
| Address2: | |||||||||
| City: | MCCOMB | ||||||||
| State: | MS | ||||||||
| PostalCode: | 396482825 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6016842481 | ||||||||
| FaxNumber: | 6016842488 | ||||||||
| Practice Location | |||||||||
| Address1: | 1311 ASTON AVE | ||||||||
| Address2: | |||||||||
| City: | MCCOMB | ||||||||
| State: | MS | ||||||||
| PostalCode: | 396482825 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6016842481 | ||||||||
| FaxNumber: | 6016842488 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/20/2006 | ||||||||
| LastUpdateDate: | 02/07/2014 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | DIXON | ||||||||
| AuthorizedOfficialFirstName: | WILLIAM | ||||||||
| AuthorizedOfficialMiddleName: | NEWELL | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6016842481 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 09423 | MS | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 1695751 | 01 | LA | LOUISIANA MEDICAID | OTHER | 0055313 | 01 | MS | MISSISSIPPI SELECT | OTHER | 020038952 | 01 | MS | RAILROAD MEDICARE | OTHER | 00117256 | 05 | MS | MEDICAID | 1730025 | 01 | MS | UNITED HEALTHCARE | OTHER | 427063722A | 01 | MS | BLUE CROSS BLUE SHIELD | OTHER | 5933484 | 01 | MS | AETNA | OTHER |