MEDICARE: REGINALD PEELER DICKERSON M.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	43777	TN
2	207RC0001X	Clinical Cardiac Electrophysiology Physician	43777	TN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00702357	OTHER	TN	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	6011931	OTHER	TN	BCBS

General Provider Information

NPI Number	:	1942290333
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REGINALD PEELER DICKERSON M.D

Provider Business Mailing Address
First Line	:	501 GREAT CIRCLE RD
Second Line	:	SUITE 200
City	:	NASHVILLE
State	:	TN
Zip	:	37228-1317
Country	:	US
Telephone Number	:	615-451-9200
Fax Number	:	615-989-4217

Provider Business Practice Location Address
First Line	:	300 STEAM PLANT RD
Second Line	:	SUITE 300
City	:	GALLATIN
State	:	TN
Zip	:	37066-3032
Country	:	US
Telephone Number	:	615-451-9200
Fax Number	:	615-989-4217

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/26/2005
Last Update Date	:	10/16/2014

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Directions to “ REGINALD PEELER DICKERSON M.D” Practice Location

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