=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114918752
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DUANE E DIXON M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/02/2005
-----------------------------------------------------
Last Update Date | 11/05/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 103 CLIFTON STREET SUITE B
-----------------------------------------------------
City | LYNCHBURG
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24501
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 434-528-4640
-----------------------------------------------------
Fax | 434-528-4643
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 103 CLIFTON STREET SUITE B
-----------------------------------------------------
City | LYNCHBURG
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24501
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 434-528-4640
-----------------------------------------------------
Fax | 434-528-4643
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207LP2900X
-----------------------------------------------------
Taxonomy Name | Pain Medicine (Anesthesiology) Physician
-----------------------------------------------------
License Number | 72372
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207LP2900X
-----------------------------------------------------
Taxonomy Name | Pain Medicine (Anesthesiology) Physician
-----------------------------------------------------
License Number | 0101254356
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------