Provider Demographics
NPI:1619405941
Name:DIXON, TARA DAWN (MD)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:DAWN
Last Name:DIXON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 9TH AVENUE, MC BOX 359792
Mailing Address - Street 2:KING COUNTY MEDICAL EXAMINERS OFFICE
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104
Mailing Address - Country:US
Mailing Address - Phone:206-731-3232
Mailing Address - Fax:206-731-8555
Practice Address - Street 1:325 9TH AVE
Practice Address - Street 2:KING COUNTY MEDICAL EXAMINERS OFFICE
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104
Practice Address - Country:US
Practice Address - Phone:206-731-3232
Practice Address - Fax:206-731-8555
Is Sole Proprietor?:No
Enumeration Date:2017-05-31
Last Update Date:2018-01-26
Deactivation Date:2018-01-03
Deactivation Code:
Reactivation Date:2018-01-26
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program