Provider Demographics
NPI:1386625713
Name:DIXON, THOMAS MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:MICHAEL
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:PO BOX 30033
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79120-0033
Mailing Address - Country:US
Mailing Address - Phone:806-242-2001
Mailing Address - Fax:806-202-2006
Practice Address - Street 1:3501 SONCY
Practice Address - Street 2:SUITE 1001
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79119-4932
Practice Address - Country:US
Practice Address - Phone:806-242-2001
Practice Address - Fax:806-202-2006
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-11
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK8621207XS0114X, 2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
No207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX161367101Medicaid
TXH27118Medicare UPIN
TX161367101Medicaid