Provider Demographics
NPI:1962457556
Name:RICHERSON, DENNIS R (MD)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:R
Last Name:RICHERSON
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 1252
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37133-1252
Mailing Address - Country:US
Mailing Address - Phone:615-396-4464
Mailing Address - Fax:615-396-6748
Practice Address - Street 1:1800 MEDICAL CENTER PKWY
Practice Address - Street 2:SUITE 330
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-2567
Practice Address - Country:US
Practice Address - Phone:615-396-4464
Practice Address - Fax:615-396-6748
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD021788207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3031595OtherBCBS
TN3063850Medicaid
TN050051105OtherRR MEDICARE
TN3031595OtherBCBS
TN3063850Medicare ID - Type Unspecified