Healthcare Provider Details

I. General information

NPI: 1962430165
Provider Name (Legal Business Name): EARL R DIXON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 07/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 COLUMBIA DR
TAMPA FL
33606-3508
US

IV. Provider business mailing address

14050 NW 14TH ST SUITE 190
SUNRISE FL
33323-2865
US

V. Phone/Fax

Practice location:
  • Phone: 813-844-7000
  • Fax:
Mailing address:
  • Phone: 800-424-3672
  • Fax: 954-377-3042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License NumberME71240
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: