Healthcare Provider Details

I. General information

NPI: 1386692796
Provider Name (Legal Business Name): CAROLYN MIGNIN DIXON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 BEE RIDGE RD SUITE 120
SARASOTA FL
34239-7223
US

IV. Provider business mailing address

3400 BEE RIDGE RD SUITE 120
SARASOTA FL
34239-7223
US

V. Phone/Fax

Practice location:
  • Phone: 941-924-1363
  • Fax: 941-921-6379
Mailing address:
  • Phone: 941-924-1363
  • Fax: 941-921-6379

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberME 43603
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: