Provider Demographics
NPI:1649274515
Name:BANNERMAN, DANA R (MD)
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:R
Last Name:BANNERMAN
Suffix:
Gender:
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 501123
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63150-0001
Mailing Address - Country:US
Mailing Address - Phone:615-284-4672
Mailing Address - Fax:615-284-5752
Practice Address - Street 1:2010 CHURCH ST
Practice Address - Street 2:STE 310
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-2012
Practice Address - Country:US
Practice Address - Phone:615-284-4672
Practice Address - Fax:615-284-5752
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN34669208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN38807461Medicaid
TN4171393OtherBLUE CROSS BLUE SHIELD
TN7082394OtherAETNA
TNH78772Medicare UPIN
TN38807461Medicare PIN