Provider Demographics
NPI:1356431472
Name:MIXON, WILLIAM ROBERT (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:ROBERT
Last Name:MIXON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3624 ISKAGNA DR
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37919-7762
Mailing Address - Country:US
Mailing Address - Phone:865-637-8079
Mailing Address - Fax:865-974-9524
Practice Address - Street 1:1818 ANDY HOLT
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37996-0001
Practice Address - Country:US
Practice Address - Phone:865-974-3135
Practice Address - Fax:865-974-2000
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TN15520207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNA97857Medicare UPIN