Provider Demographics
NPI:1790787034
Name:DIXON, DONALD J (MD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:J
Last Name:DIXON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1111 N CHINA LAKE BLVD
Mailing Address - Street 2:
Mailing Address - City:RIDGECREST
Mailing Address - State:CA
Mailing Address - Zip Code:93555-3131
Mailing Address - Country:US
Mailing Address - Phone:760-446-8281
Mailing Address - Fax:760-446-8289
Practice Address - Street 1:1111 N CHINA LAKE BLVD
Practice Address - Street 2:
Practice Address - City:RIDGECREST
Practice Address - State:CA
Practice Address - Zip Code:93555-3131
Practice Address - Country:US
Practice Address - Phone:760-446-8281
Practice Address - Fax:760-446-8289
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-01
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAC43197207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0616650001OtherDME
C43197OtherIMG MEDI-CAL MANAGED CARE
CA0103OtherJOHN DEERE
00C431970OtherBLUE CROSS
93555B122OtherWPS TRICARE
080069748OtherRAILROAD MEDICARE
CA00C431970Medicaid
00C431970OtherBLUE SHIELD
00C431970OtherCOMMERCIAL INSURANCE
00C431970OtherCOMMERCIAL INSURANCE
CA00C431970Medicaid
CA0103OtherJOHN DEERE