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NPI Code Detail

MEDICARE: DYLAN PAUL THAXTON M.D.

MEDICARE: DYLAN PAUL THAXTON M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician2007018509MO
2207Q00000XFamily Medicine PhysicianE5683AR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1609040849
Entity Type Code : Individual
Provider Name (Legal Business Name) : DYLAN PAUL THAXTON M.D.
Provider Business Mailing Address
First Line : 2223 GRANT ST
Second Line :
City : MALVERN
State : AR
Zip : 72104-4700
Country : US
Telephone Number : 501-337-9031
Fax Number : 501-337-9033
Provider Business Practice Location Address
First Line : 2223 GRANT ST
Second Line :
City : MALVERN
State : AR
Zip : 72104-4700
Country : US
Telephone Number : 501-337-9031
Fax Number : 501-337-9033
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/18/2008
Last Update Date : 11/03/2009

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