Provider Demographics
NPI:1518014323
Name:DEXHEIMER, JACOB C (MD)
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:C
Last Name:DEXHEIMER
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 1:2300 PATTERSON ST
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-1538
Mailing Address - Country:US
Mailing Address - Phone:615-342-6828
Mailing Address - Fax:615-342-6836
Practice Address - Street 1:2300 PATTERSON ST
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-1538
Practice Address - Country:US
Practice Address - Phone:615-342-6828
Practice Address - Fax:615-342-6836
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2017-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN43525207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1513451Medicaid
TN4230166OtherBCBST
TNP00730712OtherRAILROAD MEDICARE
TN01287075OtherAMERIGROUP
9173358OtherAETNA
KY7100072080OtherKY MEDICAID
TN01287075OtherAMERIGROUP