# MARK DIXON

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1912980236
- **Gender:** Man
- **Credential:** D.O.

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207RC0001X | Clinical Cardiac Electrophysiology Physician | 02001376 | IN | Yes |

## Other

- **Enumeration date:** 11/21/2005
- **Last updated:** 09/10/2020

## 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 | — |