Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | W202 | AZ |
NPI | 1154305084 |
---|---|
Provider Name | Anthea J Dixon |
First Address | Tucson, AZ 85712-2142 |
Second Address | Tucson, AZ 85712-2142 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/12/2005 |
Last Update Date | 18/06/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E00258 | (02) |