Healthcare Provider Details

I. General information

NPI: 1669792099
Provider Name (Legal Business Name): DIXIE FOX DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2010
Last Update Date: 01/05/2026
Certification Date: 01/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

751 SAPPINGTON BRIDGE RD
SULLIVAN MO
63080-2354
US

IV. Provider business mailing address

PO BOX 959318
SAINT LOUIS MO
63195-9318
US

V. Phone/Fax

Practice location:
  • Phone: 573-860-6000
  • Fax: 573-468-1379
Mailing address:
  • Phone: 573-468-1972
  • Fax: 573-468-1379

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number2010016507
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number2010016507
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: