Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | K8621 | TX |
Y | 2086S0122X | Plastic and Reconstructive Surgery | K8621 | TX |
NPI | 1386625713 |
---|---|
Provider Name | Thomas Michael Dixon |
First Address | Amarillo, TX 79120-0033 |
Second Address | Amarillo, TX 79119-4932 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/11/2005 |
Last Update Date | 11/03/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
161367101 | (05) | TX |
H27118 | (02) | TX |