MEDICARE: DARRYL DEAN NIX D.O.

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	207Q00000X	Family Medicine Physician	F9883	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8R6743	OTHER	TX	BLUE SHIELD

General Provider Information

NPI Number	:	1871502278
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DARRYL DEAN NIX D.O.

Provider Business Mailing Address
First Line	:	PO BOX 810478
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75381-0478
Country	:	US
Telephone Number	:	214-572-8835
Fax Number	:	972-759-1518

Provider Business Practice Location Address
First Line	:	2300 VALLEY VIEW LN
Second Line	:	100
City	:	FARMERS BRANCH
State	:	TX
Zip	:	75234-5753
Country	:	US
Telephone Number	:	214-572-8835
Fax Number	:	972-759-1518

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

Provider Enumeration Date	:	08/05/2006
Last Update Date	:	05/29/2008

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