Provider Demographics
NPI:1417937665
Name:HIXON, TAMERA (MD)
Entity Type:Individual
Prefix:
First Name:TAMERA
Middle Name:
Last Name:HIXON
Suffix:
Gender:F
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 2370
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28359-2370
Mailing Address - Country:US
Mailing Address - Phone:910-738-8154
Mailing Address - Fax:910-671-8818
Practice Address - Street 1:2905 N ELM ST
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358-2982
Practice Address - Country:US
Practice Address - Phone:910-738-8154
Practice Address - Fax:910-671-8818
Is Sole Proprietor?:No
Enumeration Date:2006-01-21
Last Update Date:2010-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2009-01552207LP2900X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS103450OtherBCBS
P00109537OtherRAILROAD MEDICAR
KS100403500CMedicaid
P00109537OtherRAILROAD MEDICAR
H47867Medicare UPIN