Healthcare Provider Details

I. General information

NPI: 1982602421
Provider Name (Legal Business Name): ROBERT TODD DIXON P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2005
Last Update Date: 12/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5050 NE HOYT ST
PORTLAND OR
97213-2991
US

IV. Provider business mailing address

5050 NE HOYT ST
PORTLAND OR
97213-2991
US

V. Phone/Fax

Practice location:
  • Phone: 503-234-9861
  • Fax: 503-238-0873
Mailing address:
  • Phone: 503-234-9861
  • Fax: 503-238-0873

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA00543
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: