Provider Demographics
NPI:1407025653
Name:WHITNEY DIXON MD INC
Entity type:Organization
Organization Name:WHITNEY DIXON MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DEANNA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:ANGELO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-899-9616
Mailing Address - Street 1:145 MISSION RANCH BLVD
Mailing Address - Street 2:SUITE 115
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-2296
Mailing Address - Country:US
Mailing Address - Phone:530-899-9616
Mailing Address - Fax:530-899-9686
Practice Address - Street 1:145 MISSION RANCH BLVD
Practice Address - Street 2:SUITE 115
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-2296
Practice Address - Country:US
Practice Address - Phone:530-899-9616
Practice Address - Fax:530-899-9686
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-21
Last Update Date:2012-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG83663174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ24570ZOtherMEDICARE CORPORATE ID
CAG23515Medicare UPIN