Healthcare Provider Details

I. General information

NPI: 1366485328
Provider Name (Legal Business Name): STEVEN R DICKERSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 11/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 29TH AVE N SUITE 202
NASHVILLE TN
37203-1401
US

IV. Provider business mailing address

110 29TH AVE N SUITE 202
NASHVILLE TN
37203-1401
US

V. Phone/Fax

Practice location:
  • Phone: 615-327-4304
  • Fax: 615-327-7940
Mailing address:
  • Phone: 615-327-4304
  • Fax: 615-327-7940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD28027
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberMD28027
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: