Healthcare Provider Details

I. General information

NPI: 1053390880
Provider Name (Legal Business Name): ROBERT ROSS DIXON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 18TH STREET CIR SE
HICKORY NC
28602-1361
US

IV. Provider business mailing address

271 TWO LAKES LN
SPARTA NC
28675-9794
US

V. Phone/Fax

Practice location:
  • Phone: 828-322-2550
  • Fax: 828-322-7748
Mailing address:
  • Phone: 336-372-4725
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number15903
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier15903
Identifier TypeOTHER
Identifier StateNC
Identifier IssuerNC MEDICAL LICENSE
# 2
Identifier8928730
Identifier TypeMEDICAID
Identifier StateNC
Identifier Issuer
# 3
Identifier28730
Identifier TypeOTHER
Identifier StateNC
Identifier IssuerBCBS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: