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Individual
MARK DIXON
Active
Individual
MARK DIXON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Taxonomy
Speciality
Code
Description
License number
State
207RC0001X
Clinical Cardiac Electrophysiology Physician
Primary
02001376
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000497635
BLUE CROSS BLUE SHIELD IN
—
05
—
100327820
—
IN
01
—
90000561
BLUE SHIELD OF IL
—
01
—
P00386127
RAILROAD MEDICARE
—
Enumeration date
11/21/2005
Last updated
09/10/2020
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