MEDICARE: WILLIAM C DIXON 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
1	207QA0000X	Adolescent Medicine (Family Medicine) Physician	G52735	CA

General Provider Information

NPI Number	:	1851429377
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM C DIXON M.D.

Provider Business Mailing Address
First Line	:	9627 LAKEWOOD DR
Second Line	:
City	:	WINDSOR
State	:	CA
Zip	:	95492-8604
Country	:	US
Telephone Number	:	707-664-2921
Fax Number	:

Provider Business Practice Location Address
First Line	:	1801 E COTATI AVE
Second Line	:	SONOMA STATE UNIVERSITY
City	:	ROHNERT PARK
State	:	CA
Zip	:	94928-3613
Country	:	US
Telephone Number	:	707-664-2921
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/28/2007
Last Update Date	:	07/08/2007

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