Provider Demographics
NPI:1922248558
Name:ROBERT L DIXON-GORDON MD LLC
Entity Type:Organization
Organization Name:ROBERT L DIXON-GORDON MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:LAWSON
Authorized Official - Last Name:DIXON-GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:585-458-2160
Mailing Address - Street 1:2735 BUFFALO RD STE 3
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14624-1337
Mailing Address - Country:US
Mailing Address - Phone:585-458-2160
Mailing Address - Fax:585-458-2165
Practice Address - Street 1:2735 BUFFALO RD STE 3
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14624-1337
Practice Address - Country:US
Practice Address - Phone:585-458-2160
Practice Address - Fax:585-458-2165
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-22
Last Update Date:2009-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY149340207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty