Provider Demographics
NPI:1730188921
Name:DIXON, ROBERT A (DO)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:A
Last Name:DIXON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4995 BRADENTON AVE
Mailing Address - Street 2:SUITE130
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-3543
Mailing Address - Country:US
Mailing Address - Phone:614-734-5000
Mailing Address - Fax:614-734-5001
Practice Address - Street 1:4995 BRADENTON AVE
Practice Address - Street 2:SUITE130
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017-3543
Practice Address - Country:US
Practice Address - Phone:614-734-5000
Practice Address - Fax:614-734-5001
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-00-5251-D207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0849550Medicaid
OH93938Medicare UPIN
OHDI0697166Medicare ID - Type Unspecified