Provider Demographics
NPI:1346379187
Name:NIXON, RANDALL G (MD)
Entity Type:Individual
Prefix:
First Name:RANDALL
Middle Name:G
Last Name:NIXON
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 1:1425 VISTA LN
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89703-4644
Mailing Address - Country:US
Mailing Address - Phone:775-883-1030
Mailing Address - Fax:775-883-4677
Practice Address - Street 1:1425 VISTA LN
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89703-4644
Practice Address - Country:US
Practice Address - Phone:775-883-1030
Practice Address - Fax:775-883-4677
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA82439208800000X
NV10377208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100500204Medicaid
NVCC7321OtherANTHEM BCBS NEVADA
NVP00041721OtherRR MEDICARE
NE37576Medicare ID - Type UnspecifiedMINDEN MEDICARE
NV37698Medicare ID - Type UnspecifiedSTATELINE MEDICARE
NV37575Medicare ID - Type UnspecifiedCARSON CITY MEDICARE
NVCC7321OtherANTHEM BCBS NEVADA
NV37578Medicare ID - Type UnspecifiedYERINGTON MEDICARE
NVP00041721OtherRR MEDICARE
NV37699Medicare ID - Type UnspecifiedFALLON MEDICARE
NV100500204Medicaid
CA00A824390Medicare ID - Type UnspecifiedCALIF MEDICARE