MEDICARE: DR. MARCIA L HIXSON M.D.

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	C5658	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	53059C207	OTHER	AR	MEDIARE

General Provider Information

NPI Number	:	1164400412
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARCIA L HIXSON M.D.

Provider Business Mailing Address
First Line	:	3470 LANDERS RD
Second Line	:
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72117-2541
Country	:	US
Telephone Number	:	501-945-0661
Fax Number	:	501-945-0621

Provider Business Practice Location Address
First Line	:	3470 LANDERS RD
Second Line	:
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72117-2541
Country	:	US
Telephone Number	:	501-945-0661
Fax Number	:	501-945-0621

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

Provider Enumeration Date	:	01/06/2006
Last Update Date	:	11/10/2011

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