Provider Demographics
NPI:1407966468
Name:NIXON, GEORGE WILLIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:WILLIAM
Last Name:NIXON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2319 FOOTHILL DR
Mailing Address - Street 2:#130
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84109-1489
Mailing Address - Country:US
Mailing Address - Phone:801-487-0451
Mailing Address - Fax:801-487-2467
Practice Address - Street 1:100 N MEDICAL DR
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84113-1103
Practice Address - Country:US
Practice Address - Phone:801-662-1900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2024-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT148857-12052085P0229X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085P0229XAllopathic & Osteopathic PhysiciansRadiologyPediatric Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1600056OtherUNITED HEALTHCARE
UT35834OtherDESERET MUTUAL
UT870355724NI1OtherEDUCATORS MUTUAL
UT48880OtherPUBLIC EMPLOYEES HEALTH
UT8550895OtherAETNA
UT2284OtherUUHN
UT107005092101OtherSELECTHEALTH
UTQM0000027099OtherALTIUS
UTE00006Medicare UPIN