Provider Demographics
NPI:1588635593
Name:DIXON, BRIAN JEREMY (MD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:JEREMY
Last Name:DIXON
Suffix:
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 1:6000 MEMORIAL CHURCH DRIVE
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26501
Mailing Address - Country:US
Mailing Address - Phone:304-292-7316
Mailing Address - Fax:304-599-8917
Practice Address - Street 1:6000 MEMORIAL CHURCH DRIVE
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26501
Practice Address - Country:US
Practice Address - Phone:304-292-7316
Practice Address - Fax:304-599-8917
Is Sole Proprietor?:No
Enumeration Date:2006-01-28
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV20254207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
080171691OtherRAILROAD MEDICARE
080171691OtherRAILROAD MEDICARE
WV4047041Medicare PIN