Provider Demographics
NPI:1568428183
Name:DIXON, CALVIN LEE SR (MD)
Entity Type:Individual
Prefix:
First Name:CALVIN
Middle Name:LEE
Last Name:DIXON
Suffix:SR
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 1:315 S COCKRELL HILL RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:DUNCANVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75116-4041
Mailing Address - Country:US
Mailing Address - Phone:972-298-3300
Mailing Address - Fax:972-298-5505
Practice Address - Street 1:315 S COCKRELL HILL RD
Practice Address - Street 2:SUITE 102
Practice Address - City:DUNCANVILLE
Practice Address - State:TX
Practice Address - Zip Code:75116-4041
Practice Address - Country:US
Practice Address - Phone:972-298-3300
Practice Address - Fax:972-298-5505
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-22
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE4297207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX033668701Medicaid
TX033668701Medicaid
TXOOGU91Medicare ID - Type Unspecified