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Individual

DWIGHT ANTHONY DISHMON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
1251 WESLEY DR, SUITE 153, MEMPHIS, TN 38116-6442
(901) 763-0200
(901) 761-4002
Mailing address
1975 NONCONNAH BLVD, MEMPHIS, TN 38132-2108
(901) 596-4096

Taxonomy

Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
39198
TN
207RI0011X
Interventional Cardiology Physician
Primary
39198
TN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
07222339
MS
05
155106001
AR
05
3325860
TN
01
4354768
BCBS
TN
01
P01301155
RAILROAD MEDICARE
TN
Enumeration date
04/27/2006
Last updated
08/26/2021
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