MEDICARE: DIXIE L EDDY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist

General Provider Information

NPI Number	:	1033390810
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIXIE L EDDY

Provider Business Mailing Address
First Line	:	940 E LATIGO CT
Second Line	:
City	:	PAULDEN
State	:	AZ
Zip	:	86334-4903
Country	:	US
Telephone Number	:	928-830-0196
Fax Number	:

Provider Business Practice Location Address
First Line	:	940 E LATIGO CT
Second Line	:
City	:	PAULDEN
State	:	AZ
Zip	:	86334-4903
Country	:	US
Telephone Number	:	928-830-0196
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/20/2007
Last Update Date	:	11/20/2007

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Directions to “ DIXIE L EDDY ” Practice Location

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