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General NPI Number Information
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NPI Number | 1912980236
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Entity Type | Individual
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Provider Name | MARK DIXON D.O.
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Gender | Male
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Dates
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Enumeration Date | 11/21/2005
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Last Update Date | 09/10/2020
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Provider Practice Location Address
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Address Line | 85 E US HIGHWAY 6 STE 300
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City | VALPARAISO
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State | IN
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Zip | 46383-8948
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Country | US
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Telephone | 219-983-6300
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Fax | 219-983-6080
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Provider Business Mailing Address
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Address Line | 85 E US HIGHWAY 6 STE 300
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City | VALPARAISO
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State | IN
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Zip | 46383-8948
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Country | US
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Telephone | 219-983-6300
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Fax | 219-983-6080
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0001X
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Taxonomy Name | Clinical Cardiac Electrophysiology Physician
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License Number | 02001376
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License Number State | IN
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