Provider Demographics
NPI:1124134796
Name:DIXON, DAVID B (DPM)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:B
Last Name:DIXON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:30 WEST 60TH STREET
Mailing Address - Street 2:SUITE 1E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023
Mailing Address - Country:US
Mailing Address - Phone:212-957-9040
Mailing Address - Fax:212-246-4964
Practice Address - Street 1:30 WEST 60TH STREET
Practice Address - Street 2:SUITE 1E
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023
Practice Address - Country:US
Practice Address - Phone:212-957-9040
Practice Address - Fax:212-246-4964
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN35471213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
T32194Medicare UPIN
P37581Medicare ID - Type Unspecified