Provider Demographics
NPI:1386692796
Name:DIXON, CAROLYN MIGNIN (MD)
Entity type:Individual
Prefix:DR
First Name:CAROLYN
Middle Name:MIGNIN
Last Name:DIXON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:3400 BEE RIDGE RD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-7223
Mailing Address - Country:US
Mailing Address - Phone:941-924-1363
Mailing Address - Fax:941-921-6379
Practice Address - Street 1:3400 BEE RIDGE RD
Practice Address - Street 2:SUITE 120
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-7223
Practice Address - Country:US
Practice Address - Phone:941-924-1363
Practice Address - Fax:941-921-6379
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME 43603207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD56964Medicare UPIN
FL58428WMedicare ID - Type Unspecified