Provider Demographics
NPI:1356478101
Name:DIXIE DERMATOLOGY A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:DIXIE DERMATOLOGY A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSCIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:KARL
Authorized Official - Middle Name:
Authorized Official - Last Name:TRIMBLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:435-674-3552
Mailing Address - Street 1:169 W 2710 SOUTH CIR STE 101
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-7202
Mailing Address - Country:US
Mailing Address - Phone:435-674-3552
Mailing Address - Fax:
Practice Address - Street 1:169 W 2710 SOUTH CIR STE 101
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-7202
Practice Address - Country:US
Practice Address - Phone:435-674-3552
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2018-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty