Provider Demographics
NPI:1134784937
Name:DIXON, KOBY MICHAEL SR (MD)
Entity type:Individual
Prefix:DR
First Name:KOBY
Middle Name:MICHAEL
Last Name:DIXON
Suffix:SR
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 1:9228 SAWGRASS DR
Mailing Address - Street 2:
Mailing Address - City:MIAMISBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45342-6778
Mailing Address - Country:US
Mailing Address - Phone:937-572-9218
Mailing Address - Fax:
Practice Address - Street 1:6330 QUADRANGLE DR STE 500
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27517-8281
Practice Address - Country:US
Practice Address - Phone:888-849-7379
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-07
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.149721208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice