Provider Demographics
NPI:1720575632
Name:DIXON, KATHLEEN PAIGE (MD)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:PAIGE
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 1:7560 RED BUG LAKE RD STE 2048
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-6591
Mailing Address - Country:US
Mailing Address - Phone:407-366-8856
Mailing Address - Fax:407-977-4319
Practice Address - Street 1:7560 RED BUG LAKE RD STE 2048
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-6591
Practice Address - Country:US
Practice Address - Phone:407-366-8856
Practice Address - Fax:407-977-4319
Is Sole Proprietor?:No
Enumeration Date:2018-04-16
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME143330207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL105622500Medicaid