Healthcare Provider Details

I. General information

NPI: 1780796060
Provider Name (Legal Business Name): PERSHARON M DIXON M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 08/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1046 DIVISION ST
BILOXI MS
39530-2935
US

IV. Provider business mailing address

1046 DIVISION ST
BILOXI MS
39530-2935
US

V. Phone/Fax

Practice location:
  • Phone: 228-374-2494
  • Fax: 228-374-0856
Mailing address:
  • Phone: 228-374-2494
  • Fax: 228-374-0856

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number19475
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: