Provider Demographics
NPI:1003883398
Name:DIXON, DARRELL R (MD)
Entity Type:Individual
Prefix:
First Name:DARRELL
Middle Name:R
Last Name:DIXON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 COVE VIEW TRAIL CT
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77389-7592
Mailing Address - Country:US
Mailing Address - Phone:713-586-9289
Mailing Address - Fax:281-547-8241
Practice Address - Street 1:50 COVE VIEW TRAIL CT
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77389-7592
Practice Address - Country:US
Practice Address - Phone:713-586-9289
Practice Address - Fax:281-547-8241
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-05
Last Update Date:2015-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ7944207Q00000X
GA052555207Q00000X
UT165414-1205207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
D07347Medicare UPIN