Provider Demographics
NPI:1205948247
Name:DIXON, DRUERY J (MD)
Entity type:Individual
Prefix:
First Name:DRUERY
Middle Name:J
Last Name:DIXON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:181 N KENTUCKY AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WEST PLAINS
Mailing Address - State:MO
Mailing Address - Zip Code:65775-2089
Mailing Address - Country:US
Mailing Address - Phone:417-257-5911
Mailing Address - Fax:417-257-5913
Practice Address - Street 1:181 N KENTUCKY AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:WEST PLAINS
Practice Address - State:MO
Practice Address - Zip Code:65775-2089
Practice Address - Country:US
Practice Address - Phone:417-257-5911
Practice Address - Fax:417-257-5913
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ARE4127207Q00000X
MOR8G07207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO16390OtherBCBS PROVIDER NUMBER
MO202386926Medicaid
AR121380001OtherARKANSAS MEDICAID
AR121380001OtherARKANSAS MEDICAID
MOA13271Medicare UPIN