Provider Demographics
NPI:1295724003
Name:DILL, STEPHEN HURLEY (MD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:HURLEY
Last Name:DILL
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 1:744 MIDDLE CREEK RD
Mailing Address - Street 2:SUITE 114
Mailing Address - City:SEVIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37862
Mailing Address - Country:US
Mailing Address - Phone:865-446-9575
Mailing Address - Fax:865-446-9576
Practice Address - Street 1:744 MIDDLE CREEK RD
Practice Address - Street 2:SUITE 114
Practice Address - City:SEVIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:37862
Practice Address - Country:US
Practice Address - Phone:865-446-9575
Practice Address - Fax:865-446-9576
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-14
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000007844207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3859890Medicaid
SCQ07845Medicaid
B59355Medicare UPIN
SCQ07845Medicaid
TN3734041Medicare PIN
TN3859891Medicare ID - Type Unspecified