Organization Active NPI

Robert W Dixon Jr MD PC

  • Family Medicine Physician
  • Grand Haven, MI
National Provider Identifier
1023284304
Registry record updated Oct 8, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
4301035255 Issued in MI
Legal business name
ROBERT W DIXON JR MD PC
Practice address
1310 Wisconsin Ave
Suite 200
Grand Haven, MI 49417-2472
Phone
(616) 846-2640
Fax
(616) 846-3110
NPI assigned
May 6, 2008
Last updated
Oct 8, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 8, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Robert W Dixon Jr., MD
Title
Owner
Phone
(616) 846-2640

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 4301035255 MI Primary

Addresses

Primary practice location

1310 Wisconsin Ave
Suite 200
Grand Haven, MI 49417-2472

Mailing address

1310 Wisconsin Ave
Suite 200
Grand Haven, MI 49417-2472
Phone (616) 846-2640

Other identifiers 1

IdentifierTypeStateIssuer
1363656MedicaidMI

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1210032000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1223424000000",
    "number": "1023284304",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1310 WISCONSIN AVE",
            "address_2": "SUITE 200",
            "city": "GRAND HAVEN",
            "state": "MI",
            "postal_code": "494172472",
            "telephone_number": "616-846-2640",
            "fax_number": "616-846-3110"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1310 WISCONSIN AVE",
            "address_2": "SUITE 200",
            "city": "GRAND HAVEN",
            "state": "MI",
            "postal_code": "494172472",
            "telephone_number": "616-846-2640",
            "fax_number": "616-846-3110"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROBERT W DIXON JR MD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-06",
        "last_updated": "2008-10-08",
        "status": "A",
        "authorized_official_last_name": "DIXON",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "616-846-2640",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "4301035255",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1363656",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Haven, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.