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NPI Code Detail

MEDICARE: DR. JACOB KILEY DIXON MD

MEDICARE: DR. JACOB KILEY DIXON MD
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
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1184253668
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JACOB KILEY DIXON MD
Provider Business Mailing Address
First Line : 11175 CAMPUS ST STE 21108
Second Line :
City : LOMA LINDA
State : CA
Zip : 92350-1700
Country : US
Telephone Number : 909-558-4289
Fax Number : 909-558-4872
Provider Business Practice Location Address
First Line : 11234 ANDERSON ST
Second Line : GME OFFICE WESTERLY SUITE C
City : LOMA LINDA
State : CA
Zip : 92354-2804
Country : US
Telephone Number : 909-558-2822
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/06/2020
Last Update Date : 04/22/2026

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