Provider Demographics
NPI:1649348434
Name:DIXON, THOMAS ANDREW (MD)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:ANDREW
Last Name:DIXON
Suffix:
Gender:M
Credentials:MD
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 625
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:OK
Mailing Address - Zip Code:73096-0625
Mailing Address - Country:US
Mailing Address - Phone:580-772-6013
Mailing Address - Fax:580-772-5816
Practice Address - Street 1:506 N CUSTER
Practice Address - Street 2:
Practice Address - City:WEATHERFORD
Practice Address - State:OK
Practice Address - Zip Code:73096
Practice Address - Country:US
Practice Address - Phone:580-772-6013
Practice Address - Fax:580-772-5816
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK11395207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
D38752Medicare UPIN