Provider Demographics
NPI:1871502278
Name:NIX, DARRYL DEAN (DO)
Entity Type:Individual
Prefix:
First Name:DARRYL
Middle Name:DEAN
Last Name:NIX
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 810478
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75381-0478
Mailing Address - Country:US
Mailing Address - Phone:214-572-8835
Mailing Address - Fax:972-759-1518
Practice Address - Street 1:2300 VALLEY VIEW LN
Practice Address - Street 2:100
Practice Address - City:FARMERS BRANCH
Practice Address - State:TX
Practice Address - Zip Code:75234-5753
Practice Address - Country:US
Practice Address - Phone:214-572-8835
Practice Address - Fax:972-759-1518
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF9883207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8R6743OtherBLUE SHIELD
TXD79622Medicare UPIN