Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 46135 | KY |
NPI | 1013182443 |
---|---|
Provider Name | Dr. Justin Kevin Dixon |
First Address | Ashland, KY 41101-1900 |
Second Address | Ashland, KY 41101-1900 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/04/2008 |
Last Update Date | 01/04/2014 |