Provider Demographics
NPI:1881815413
Name:DIXON, WILLAIM LEWIS (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLAIM
Middle Name:LEWIS
Last Name:DIXON
Suffix:
Gender:M
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:PO BOX 100371
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32610
Mailing Address - Country:US
Mailing Address - Phone:352-733-0064
Mailing Address - Fax:352-265-0627
Practice Address - Street 1:801 SW 2ND AVE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32601
Practice Address - Country:US
Practice Address - Phone:352-733-0064
Practice Address - Fax:352-733-0016
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME36997208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
D52015Medicare UPIN
FL09051AMedicare ID - Type Unspecified