Provider Demographics
NPI:1023079613
Name:DIXON, FREDERICK EARL (MD)
Entity type:Individual
Prefix:
First Name:FREDERICK
Middle Name:EARL
Last Name:DIXON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:EARL
Other - Middle Name:
Other - Last Name:DIXON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:326 N LBJ DR STE 104
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:TX
Mailing Address - Zip Code:78666-5624
Mailing Address - Country:US
Mailing Address - Phone:512-572-1033
Mailing Address - Fax:
Practice Address - Street 1:326 N LBJ DR STE 104
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:TX
Practice Address - Zip Code:78666-5624
Practice Address - Country:US
Practice Address - Phone:512-572-1033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-31
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL5723207RC0000X, 207RS0012X, 207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8G0097Medicare PIN
TXTXB108863Medicare PIN