Provider Demographics
NPI:1174508386
Name:DIXON, RODNEY M (MD)
Entity Type:Individual
Prefix:
First Name:RODNEY
Middle Name:M
Last Name:DIXON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:RODNEY
Other - Middle Name:MARK
Other - Last Name:DIXON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:600 S TIMBERLANE DR
Mailing Address - Street 2:
Mailing Address - City:EL DORADO
Mailing Address - State:AR
Mailing Address - Zip Code:71730-6990
Mailing Address - Country:US
Mailing Address - Phone:870-862-1891
Mailing Address - Fax:870-862-1891
Practice Address - Street 1:600 S TIMBERLANE DR
Practice Address - Street 2:
Practice Address - City:EL DORADO
Practice Address - State:AR
Practice Address - Zip Code:71730-6990
Practice Address - Country:US
Practice Address - Phone:870-862-2400
Practice Address - Fax:870-862-1891
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-09
Last Update Date:2014-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC-6222207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR51385OtherBCBS
AR106186001Medicaid
LA1112496Medicaid
C68163Medicare UPIN
AR51385Medicare PIN