MEDICARE: PAUL R HIXON RT

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	247100000X	Radiologic Technologist	240949
2	247100000X	Radiologic Technologist	29360	FL

General Provider Information

NPI Number	:	1487855284
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAUL R HIXON RT

Provider Business Mailing Address
First Line	:	5216 JOSHUA LN
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32404-6387
Country	:	US
Telephone Number	:	850-747-7777
Fax Number	:

Provider Business Practice Location Address
First Line	:	2024 STATE AVE
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32405-4558
Country	:	US
Telephone Number	:	850-747-7777
Fax Number	:

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

Provider Enumeration Date	:	05/30/2007
Last Update Date	:	07/08/2007

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