Provider Demographics
NPI:1225026438
Name:DIXON, TIMOTHY K (MD)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:K
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 1:336 29TH ST STE 101
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41101-1976
Mailing Address - Country:US
Mailing Address - Phone:606-324-4404
Mailing Address - Fax:606-325-6822
Practice Address - Street 1:336 29TH ST
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-1900
Practice Address - Country:US
Practice Address - Phone:606-324-4404
Practice Address - Fax:606-325-6822
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY29603208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64296031Medicaid
C70047Medicare UPIN
KY64296031Medicaid