Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 27723 | IA |
N | 111NI0900X | Internist | 27723 | IA |
Y | 207RN0300X | Nephrologist | 27723 | IA |
NPI | 1053393363 |
---|---|
Provider Name | Bradley S Dixon |
First Address | Iowa City, IA 52242-1009 |
Second Address | Iowa City, IA 52242-1009 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/11/2005 |
Last Update Date | 29/11/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00252 | WELLMARK BCBS (01) | IA |
0065268 | (05) | IA |
E67891 | (02) |