Provider Demographics
NPI:1609047265
Name:DIXON, DOUGLAS MICHAEL (MD,)
Entity Type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:MICHAEL
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 1:720 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-4647
Mailing Address - Country:US
Mailing Address - Phone:910-762-9995
Mailing Address - Fax:910-762-2134
Practice Address - Street 1:720 MARKET ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-4647
Practice Address - Country:US
Practice Address - Phone:910-762-9995
Practice Address - Fax:910-762-2134
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-21
Last Update Date:2008-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC129UTOtherBLUE CROSS BLUE SHIELD
NC7405736001OtherCIGNA HEALTHCARE
NCC2480OtherMEDCOST PREFERRED
NC0400522OtherUNITED HEALTHCARE
NCC2480OtherMEDCOST PREFERRED
NC2290283AMedicare PIN