Provider Demographics
NPI:1215912092
Name:NIXON, CHARLES RICHARD II (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:RICHARD
Last Name:NIXON
Suffix:II
Gender:M
Credentials:MD
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Mailing Address - Street 1:BOX 788250
Mailing Address - Street 2:NAVAL HOSPITAL, ATTN PROFESSIONAL AFFAIRS
Mailing Address - City:TWENTYNINE PALMS
Mailing Address - State:CA
Mailing Address - Zip Code:92278-8250
Mailing Address - Country:US
Mailing Address - Phone:760-830-2194
Mailing Address - Fax:760-830-2576
Practice Address - Street 1:NAVAL HOSPITAL, ATTN PROFESSIONAL AFFAIRS
Practice Address - Street 2:BOX 788250
Practice Address - City:TWENTYNINE PALMS
Practice Address - State:CA
Practice Address - Zip Code:92278-8250
Practice Address - Country:US
Practice Address - Phone:760-830-2194
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME 54671207P00000X
NC207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine