Provider Demographics
NPI:1780789180
Name:DIXON, KEITH ALAN (MD)
Entity type:Individual
Prefix:
First Name:KEITH
Middle Name:ALAN
Last Name:DIXON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:4509 EAST MCCAIN BLDV
Mailing Address - Street 2:
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72117
Mailing Address - Country:US
Mailing Address - Phone:501-945-8080
Mailing Address - Fax:501-945-5040
Practice Address - Street 1:4509 E MCCAIN BLVD
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72117-2902
Practice Address - Country:US
Practice Address - Phone:501-945-8080
Practice Address - Fax:501-945-5040
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ARR3514207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR3120013OtherUNITED HEALTH CARE
AR042548OtherMEDICARE PART A
AR51377OtherBLUE CROSS BLUE SHIELD
AR1238100005OtherQUALCHOICE
AR51377OtherBLUE CROSS BLUE SHIELD
AR1238100005OtherQUALCHOICE