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General NPI Number Information
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NPI Number | 1265677751
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Entity Type | Organization
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Legal Business Name | DIXON NEPHROLOGY MEDICAL GROUP
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Dates
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Enumeration Date | 12/11/2008
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Last Update Date | 12/11/2008
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Provider Practice Location Address
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Address Line | 125 N LINCOLN ST STE D
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City | DIXON
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State | CA
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Zip | 95620-3259
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Country | US
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Telephone | 707-678-5600
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Fax | 707-678-5610
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Provider Business Mailing Address
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Address Line | 520 COTTONWOOD ST STE 2
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City | WOODLAND
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State | CA
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Zip | 95695-3603
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Country | US
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Telephone | 530-668-3600
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Fax | 530-668-3601
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Authorized Official
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Title or Position | COO
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Name | KEITH R VOLKERTS
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Credential |
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Telephone | 530-668-3600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | G43354
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License Number State | CA
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