Provider Demographics
NPI:1659486736
Name:W N DIXON MD PA
Entity Type:Organization
Organization Name:W N DIXON MD PA
Other - Org Name:WILLIAM N DIXON MD
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:NEWELL
Authorized Official - Last Name:DIXON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:601-684-2481
Mailing Address - Street 1:1311 ASTON AVE
Mailing Address - Street 2:
Mailing Address - City:MCCOMB
Mailing Address - State:MS
Mailing Address - Zip Code:39648-2825
Mailing Address - Country:US
Mailing Address - Phone:601-684-2481
Mailing Address - Fax:601-684-2488
Practice Address - Street 1:1311 ASTON AVE
Practice Address - Street 2:
Practice Address - City:MCCOMB
Practice Address - State:MS
Practice Address - Zip Code:39648-2825
Practice Address - Country:US
Practice Address - Phone:601-684-2481
Practice Address - Fax:601-684-2488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS09423208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1695751OtherLOUISIANA MEDICAID
MS0055313OtherMISSISSIPPI SELECT
MS020038952OtherRAILROAD MEDICARE
MS00117256Medicaid
MS1730025OtherUNITED HEALTHCARE
MS427063722AOtherBLUE CROSS BLUE SHIELD
MS5933484OtherAETNA
MS427063722AOtherBLUE CROSS BLUE SHIELD
MS1730025OtherUNITED HEALTHCARE