Provider Demographics
NPI:1063465011
Name:NIXON, JAMES E (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:E
Last Name:NIXON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2004 1ST AVE
Mailing Address - Street 2:STE A
Mailing Address - City:DODGE CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67801-2623
Mailing Address - Country:US
Mailing Address - Phone:620-225-1033
Mailing Address - Fax:620-227-8491
Practice Address - Street 1:2004 1ST AVE
Practice Address - Street 2:STE A
Practice Address - City:DODGE CITY
Practice Address - State:KS
Practice Address - Zip Code:67801-2623
Practice Address - Country:US
Practice Address - Phone:620-225-1033
Practice Address - Fax:620-227-8491
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2008-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0418445174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSKA1172002OtherMEDICARE
CO14956861Medicaid
KSKA1173002OtherMEDICARE
KS100148400BMedicaid
CO395928Medicare ID - Type Unspecified
KSKA1172002OtherMEDICARE
KS002697Medicare ID - Type Unspecified