Provider Demographics
NPI:1710411996
Name:DIXON, LEROME
Entity Type:Individual
Prefix:MR
First Name:LEROME
Middle Name:
Last Name:DIXON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 W PALM VALLEY BLVD STE 243
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78664-4200
Mailing Address - Country:US
Mailing Address - Phone:512-373-2353
Mailing Address - Fax:
Practice Address - Street 1:402 W PALM VALLEY BLVD STE A
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78664-4200
Practice Address - Country:US
Practice Address - Phone:512-373-2353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80-04174687251K00000X
TX80-0417468253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251K00000XAgenciesPublic Health or Welfare