Provider Demographics
NPI:1831156140
Name:DHILLON, JASBIR S (DO)
Entity type:Individual
Prefix:
First Name:JASBIR
Middle Name:S
Last Name:DHILLON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9025 OVERLOOK BLVD
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-2708
Mailing Address - Country:US
Mailing Address - Phone:615-377-6668
Mailing Address - Fax:
Practice Address - Street 1:100 NORTHCREST DR
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:TN
Practice Address - Zip Code:37172-3927
Practice Address - Country:US
Practice Address - Phone:615-384-1536
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2012-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDO0000002190207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64025141Medicaid
KY1095948OtherPASSPORT
KY1095948OtherPASSPORT HEALTH PLAN
KY2436109000OtherPASSPORT ADVANTAGE
KY3317865Medicare PIN
KY1095948OtherPASSPORT HEALTH PLAN
3317865Medicare PIN
KY1095948OtherPASSPORT