Individual
DR. ROBERT T NIXON JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
420 N IL ROUTE 31, CRYSTAL LAKE, IL 60012
(815) 356-5200
(815) 356-5262
Mailing address
420 N IL ROUTE 31, CRYSTAL LAKE, IL 60012-3709
(815) 356-5200
(815) 356-5262
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
036078380
IL
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
Primary
036-078380
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
036078380
STATE LICENSE
IL
05
—
036078380
—
IL
Enumeration date
11/15/2006
Last updated
10/19/2018
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