Provider Demographics
NPI:1366485328
Name:DICKERSON, STEVEN R (MD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:R
Last Name:DICKERSON
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 1:110 29TH AVE N
Mailing Address - Street 2:SUITE 202
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-1401
Mailing Address - Country:US
Mailing Address - Phone:615-327-4304
Mailing Address - Fax:615-327-7940
Practice Address - Street 1:110 29TH AVE N
Practice Address - Street 2:SUITE 202
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-1401
Practice Address - Country:US
Practice Address - Phone:615-327-4304
Practice Address - Fax:615-327-7940
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2015-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD28027207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN10070175OtherAMERIGROUP
TN3154927OtherBCBS
KY64006620OtherKY MEDICAID
TN050076661OtherRAILROAD MEDICARE
TN1629350OtherFIRST HEALTH
TN3800326Medicaid
TNG28187Medicare UPIN
TN3800328Medicare PIN