MEDICARE: JOHN D HIXSON 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
1	2084N0400X	Neurology Physician	36161	IA
2	2084N0600X	Clinical Neurophysiology Physician	36161	IA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	39654	OTHER	IA	WELLMARK BCBS
2	A96211	OTHER	CA	STATE LICENSE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1336130475
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN D HIXSON MD

Provider Business Mailing Address
First Line	:	400 PARNASSUS AVE BOX 0138
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94143-0001
Country	:	US
Telephone Number	:	415-353-2437
Fax Number	:	415-353-2837

Provider Business Practice Location Address
First Line	:	400 PARNASSUS AVE BOX 0138
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94143-0001
Country	:	US
Telephone Number	:	415-353-2437
Fax Number	:	415-353-2837

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

Provider Enumeration Date	:	10/28/2005
Last Update Date	:	02/12/2010

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Directions to “ JOHN D HIXSON MD” Practice Location

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