Healthcare Provider Details

I. General information

NPI: 1851429377
Provider Name (Legal Business Name): WILLIAM C DIXON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 E COTATI AVE SONOMA STATE UNIVERSITY
ROHNERT PARK CA
94928-3613
US

IV. Provider business mailing address

9627 LAKEWOOD DR
WINDSOR CA
95492-8604
US

V. Phone/Fax

Practice location:
  • Phone: 707-664-2921
  • Fax:
Mailing address:
  • Phone: 707-664-2921
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0000X
TaxonomyAdolescent Medicine (Family Medicine) Physician
License NumberG52735
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: