Healthcare Provider Details

I. General information

NPI: 1609096775
Provider Name (Legal Business Name): PAXTON V. DICKSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2007
Last Update Date: 07/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7945 WOLF RIVER BLVD SUITE 289
GERMANTOWN TN
38138-1762
US

IV. Provider business mailing address

910 MADISON AVE SUITE 303
MEMPHIS TN
38103-3403
US

V. Phone/Fax

Practice location:
  • Phone: 901-347-8270
  • Fax:
Mailing address:
  • Phone: 901-448-1498
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License NumberMD0000048546
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD0000048546
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: