Provider Demographics
NPI:1457328049
Name:HULM, DENNIS ALFRED (MD)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:ALFRED
Last Name:HULM
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:PO BOX 11955
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38308-0132
Mailing Address - Country:US
Mailing Address - Phone:888-630-0845
Mailing Address - Fax:
Practice Address - Street 1:620 SKYLINE DRIVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38301-3901
Practice Address - Country:US
Practice Address - Phone:731-541-6174
Practice Address - Fax:731-541-8008
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD378942085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3888479Medicaid
TN3888478Medicaid
4102674OtherBCBS
P00109839OtherRR MEDICARE
P00264044OtherRR MEDICARE
HIDC538ZOtherPALMETTO HAWAII
TN3888472Medicaid
4068852OtherBCBS
TN3888472Medicare PIN
TNH65408Medicare UPIN
TN3888478Medicaid
P00109839OtherRR MEDICARE