Healthcare Provider Details

I. General information

NPI: 1154305084
Provider Name (Legal Business Name): ANTHEA J DIXON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2005
Last Update Date: 06/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5190 E FARNESS DR #106
TUCSON AZ
85712-2142
US

IV. Provider business mailing address

5190 E FARNESS DR #106
TUCSON AZ
85712-2142
US

V. Phone/Fax

Practice location:
  • Phone: 520-323-3103
  • Fax: 520-327-8999
Mailing address:
  • Phone: 520-323-3103
  • Fax: 520-327-8999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberW202
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: