Provider Demographics
NPI:1144262130
Name:DIXON, KIM C (MD)
Entity type:Individual
Prefix:DR
First Name:KIM
Middle Name:C
Last Name:DIXON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 HOW LN
Mailing Address - Street 2:
Mailing Address - City:NEW BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08901-3653
Mailing Address - Country:US
Mailing Address - Phone:732-745-8600
Mailing Address - Fax:732-729-0869
Practice Address - Street 1:123 HOW LN
Practice Address - Street 2:
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901-3653
Practice Address - Country:US
Practice Address - Phone:732-745-8600
Practice Address - Fax:732-729-0869
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA07134200207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJP00087647OtherRAILROAD MEDICARE
NJ0022471Medicaid
NJP00087647OtherRAILROAD MEDICARE
NJ0022471Medicaid