Healthcare Provider Details

I. General information

NPI: 1538850896
Provider Name (Legal Business Name): CONNOR SCULLY DIXON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2023
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

817 COMMERCIAL ST
LEAVENWORTH WA
98826-1316
US

IV. Provider business mailing address

817 COMMERCIAL ST
LEAVENWORTH WA
98826-1316
US

V. Phone/Fax

Practice location:
  • Phone: 509-548-5815
  • Fax: 509-548-2510
Mailing address:
  • Phone: 509-548-5815
  • Fax: 509-548-2510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number210824
License Number StateAK
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD70123318
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: