MEDICARE: RANDALL G NIXON 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	208800000X	Urology Physician	A82439	CA
2	208800000X	Urology Physician	10377	NV

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	CC7321	OTHER	NV	ANTHEM BCBS NEVADA

General Provider Information

NPI Number	:	1346379187
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RANDALL G NIXON M.D.

Provider Business Mailing Address
First Line	:	1425 VISTA LN
Second Line	:
City	:	CARSON CITY
State	:	NV
Zip	:	89703-4644
Country	:	US
Telephone Number	:	775-883-1030
Fax Number	:	775-883-4677

Provider Business Practice Location Address
First Line	:	1425 VISTA LN
Second Line	:
City	:	CARSON CITY
State	:	NV
Zip	:	89703-4644
Country	:	US
Telephone Number	:	775-883-1030
Fax Number	:	775-883-4677

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

Provider Enumeration Date	:	03/05/2007
Last Update Date	:	11/08/2022

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