Provider Demographics
NPI:1770265019
Name:DIXON, DAMIS F
Entity type:Individual
Prefix:MR
First Name:DAMIS
Middle Name:F
Last Name:DIXON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4760 S PECOS RD STE 203-1
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121-6038
Mailing Address - Country:US
Mailing Address - Phone:702-966-6306
Mailing Address - Fax:
Practice Address - Street 1:3836 HOLLYCROFT DR
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89081-6636
Practice Address - Country:US
Practice Address - Phone:725-261-1661
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-04
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner