Healthcare Provider Details

I. General information

NPI: 1265677751
Provider Name (Legal Business Name): DIXON NEPHROLOGY MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2008
Last Update Date: 12/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 N LINCOLN ST STE D
DIXON CA
95620-3259
US

IV. Provider business mailing address

520 COTTONWOOD ST STE 2
WOODLAND CA
95695-3603
US

V. Phone/Fax

Practice location:
  • Phone: 707-678-5600
  • Fax: 707-678-5610
Mailing address:
  • Phone: 530-668-3600
  • Fax: 530-668-3601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberG43354
License Number StateCA

VIII. Authorized Official

Name: KEITH R VOLKERTS
Title or Position: COO
Credential:
Phone: 530-668-3600