Provider Demographics
NPI:1386750461
Name:MIXON, MICHAEL
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:MIXON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1213 DARTMOUTH CIR
Mailing Address - Street 2:
Mailing Address - City:MURPHY
Mailing Address - State:TX
Mailing Address - Zip Code:75094-4112
Mailing Address - Country:US
Mailing Address - Phone:972-384-1229
Mailing Address - Fax:214-703-0147
Practice Address - Street 1:8602 LAKEVIEW PKWY
Practice Address - Street 2:SUITE E
Practice Address - City:ROWLETT
Practice Address - State:TX
Practice Address - Zip Code:75088-4398
Practice Address - Country:US
Practice Address - Phone:214-703-3764
Practice Address - Fax:214-703-1047
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ1317207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB64142Medicare UPIN
TX00J87GMedicare ID - Type Unspecified