Provider Demographics
NPI:1316164890
Name:DIXON, JAMES BRYAN (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:BRYAN
Last Name:DIXON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1414 W FAIR AVENUE
Mailing Address - Street 2:SUITE 190
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855
Mailing Address - Country:US
Mailing Address - Phone:906-225-1321
Mailing Address - Fax:906-228-9371
Practice Address - Street 1:1414 W FAIR AVE
Practice Address - Street 2:SUITE 190
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-2675
Practice Address - Country:US
Practice Address - Phone:906-225-4822
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2017-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301083794207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1316164890Medicaid
MIJD083794OtherBCBS OF MICHIGAN
MI1316164890Medicaid