Healthcare Provider Details

I. General information

NPI: 1386750461
Provider Name (Legal Business Name): DR. MICHAEL MIXON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8602 LAKEVIEW PKWY SUITE E
ROWLETT TX
75088-4398
US

IV. Provider business mailing address

1213 DARTMOUTH CIR
MURPHY TX
75094-4112
US

V. Phone/Fax

Practice location:
  • Phone: 214-703-3764
  • Fax: 214-703-1047
Mailing address:
  • Phone: 972-384-1229
  • Fax: 214-703-0147

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberJ1317
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: