Provider Demographics
NPI:1184610727
Name:DIXON, DAVID (CRNA)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:DIXON
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1932 COUNTY ROAD 213
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:OH
Mailing Address - Zip Code:43420-9185
Mailing Address - Country:US
Mailing Address - Phone:419-639-3545
Mailing Address - Fax:
Practice Address - Street 1:2801 BAY PARK DR
Practice Address - Street 2:DEPARTMENT OF SURGERY
Practice Address - City:OREGON
Practice Address - State:OH
Practice Address - Zip Code:43616-4920
Practice Address - Country:US
Practice Address - Phone:419-690-7652
Practice Address - Fax:419-697-7726
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA04747NA367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000479828OtherANTHEM
OH2144745Medicaid
OH000000349837OtherANTHEM
OH341881145-003OtherMMO
OH04097AOtherPARAMOUNT
OHP00360516OtherRRMC
OH341881145-003OtherMMO
OH000000349837OtherANTHEM
P00126779Medicare ID - Type UnspecifiedRAILROAD