Healthcare Provider Details

I. General information

NPI: 1215201595
Provider Name (Legal Business Name): RODNEY DIXON DORAND M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/03/2012
Last Update Date: 03/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 BLUE MOUNTAIN RD
SANTA ROSA BEACH FL
32459-5122
US

IV. Provider business mailing address

530 BLUE MOUNTAIN RD
SANTA ROSA BEACH FL
32459-5122
US

V. Phone/Fax

Practice location:
  • Phone: 334-399-9553
  • Fax: 850-267-0359
Mailing address:
  • Phone: 334-399-9553
  • Fax: 850-267-0359

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME56208
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: