Provider Demographics
NPI:1225089188
Name:DIXON, TYRONE W (PA)
Entity Type:Individual
Prefix:
First Name:TYRONE
Middle Name:W
Last Name:DIXON
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4141 N MIAMI AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33127-2848
Mailing Address - Country:US
Mailing Address - Phone:305-573-4442
Mailing Address - Fax:305-573-4447
Practice Address - Street 1:2108 W IDLEWILD AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33603-1038
Practice Address - Country:US
Practice Address - Phone:813-878-2606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA3068363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP11505Medicare UPIN
FLE4423WMedicare ID - Type Unspecified