Provider Demographics
NPI:1245661289
Name:NIXON, EDDIE LEE (DO)
Entity type:Individual
Prefix:
First Name:EDDIE
Middle Name:LEE
Last Name:NIXON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 517
Mailing Address - Street 2:
Mailing Address - City:MENARD
Mailing Address - State:TX
Mailing Address - Zip Code:76859-0517
Mailing Address - Country:US
Mailing Address - Phone:325-396-3372
Mailing Address - Fax:
Practice Address - Street 1:5372 WADDELL LANE
Practice Address - Street 2:
Practice Address - City:MENARD
Practice Address - State:TX
Practice Address - Zip Code:76859-0517
Practice Address - Country:US
Practice Address - Phone:325-396-3372
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-02
Last Update Date:2013-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF7000208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice