Provider Demographics
NPI:1972650695
Name:DIXON, NEAL (PA)
Entity Type:Individual
Prefix:MR
First Name:NEAL
Middle Name:
Last Name:DIXON
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:264 HIGHLAND SPRINGS AVENUE BLDG 1B
Mailing Address - Street 2:
Mailing Address - City:BANNING
Mailing Address - State:CA
Mailing Address - Zip Code:92220-0000
Mailing Address - Country:US
Mailing Address - Phone:951-769-7191
Mailing Address - Fax:
Practice Address - Street 1:264 HIGHLAND SPRINGS AVENUE
Practice Address - Street 2:BUILDING 1B
Practice Address - City:BANNING
Practice Address - State:CA
Practice Address - Zip Code:92220-4823
Practice Address - Country:US
Practice Address - Phone:951-769-7191
Practice Address - Fax:951-769-7195
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2013-06-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPA14145363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical