Provider Demographics
NPI:1558498402
Name:DIXON, RALPH SYLVAN (DPM)
Entity Type:Individual
Prefix:DR
First Name:RALPH
Middle Name:SYLVAN
Last Name:DIXON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1405 KELLUM ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701-4189
Mailing Address - Country:US
Mailing Address - Phone:907-451-9202
Mailing Address - Fax:907-452-6256
Practice Address - Street 1:1405 KELLUM ST
Practice Address - Street 2:SUITE 200
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-4189
Practice Address - Country:US
Practice Address - Phone:907-451-9202
Practice Address - Fax:907-452-6256
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK2810213E00000X
UT1045450501213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKPO5595Medicaid
U33481Medicare UPIN
0000SGBKZMedicare ID - Type Unspecified