Provider Demographics
NPI:1487855284
Name:HIXON, PAUL R (RT)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:R
Last Name:HIXON
Suffix:
Gender:M
Credentials:RT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5216 JOSHUA LN
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32404-6387
Mailing Address - Country:US
Mailing Address - Phone:850-747-7777
Mailing Address - Fax:
Practice Address - Street 1:2024 STATE AVE
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-4558
Practice Address - Country:US
Practice Address - Phone:850-747-7777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
240949247100000X
FL29360247100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic Technologist