Healthcare Provider Details

I. General information

NPI: 1518014323
Provider Name (Legal Business Name): JACOB C DEXHEIMER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 03/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 PATTERSON ST
NASHVILLE TN
37203-1538
US

IV. Provider business mailing address

2300 PATTERSON ST
NASHVILLE TN
37203-1538
US

V. Phone/Fax

Practice location:
  • Phone: 615-342-6828
  • Fax: 615-342-6836
Mailing address:
  • Phone: 615-342-6828
  • Fax: 615-342-6836

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number43525
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number43525
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: