Provider Demographics
NPI:1790968691
Name:DIXON, LARRY DARNIEL
Entity Type:Individual
Prefix:MR
First Name:LARRY
Middle Name:DARNIEL
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 1:8805 SOLON RD
Mailing Address - Street 2:G5
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77064-1222
Mailing Address - Country:US
Mailing Address - Phone:281-477-8802
Mailing Address - Fax:
Practice Address - Street 1:8805 SOLON RD
Practice Address - Street 2:G5
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77064-1222
Practice Address - Country:US
Practice Address - Phone:281-477-8802
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-13
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17851528261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center