Provider Demographics
NPI:1770563645
Name:DIXON, GARRETT WARD (MD)
Entity type:Individual
Prefix:DR
First Name:GARRETT
Middle Name:WARD
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 1:425 13TH ST
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:PA
Mailing Address - Zip Code:16323-1396
Mailing Address - Country:US
Mailing Address - Phone:814-432-3308
Mailing Address - Fax:
Practice Address - Street 1:425 13TH ST
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:PA
Practice Address - Zip Code:16323-1345
Practice Address - Country:US
Practice Address - Phone:814-432-3308
Practice Address - Fax:814-432-0072
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-18
Last Update Date:2014-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD030149E208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001048958Medicaid
DI151085Medicare ID - Type Unspecified
C32006Medicare UPIN