Provider Demographics
NPI:1710075601
Name:DIXON-GORDON, ROBERT LAWSON (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:LAWSON
Last Name:DIXON-GORDON
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 1:2300 BUFFALO RD BLDG 800
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14624-1360
Mailing Address - Country:US
Mailing Address - Phone:585-368-6370
Mailing Address - Fax:585-368-6371
Practice Address - Street 1:2300 BUFFALO RD BLDG 800
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14624-1360
Practice Address - Country:US
Practice Address - Phone:585-368-6370
Practice Address - Fax:585-368-6371
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2018-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY149340207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01350150Medicaid
NYP010149340OtherEXCELLUS BCBS
NYP010149340OtherBLUE CHOICE
NY0001912137001OtherUHC MANAGED CARE
NY100972BJOtherPREFERRED CARE
NY5083501OtherAETNA
NY149340-2OtherWORKERS COMPENSATION
NY5083501OtherAETNA
NYP010149340OtherEXCELLUS BCBS