Individual
MR. JEFFREY W DICKERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
991 MEDICAL PARK DRIVE, STE 202, MAYSVILLE, KY 41056
(606) 759-8000
(606) 759-0461
Mailing address
4071 TATES CREEK CENTRE DR, STE 202, LEXINGTON, KY 40517-3094
(859) 971-4695
(859) 971-4604
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
25880
KY
207RP1001X
Pulmonary Disease Physician
25880
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000322098
ANTHEM
—
01
—
1210239
CHA
—
05
—
2473210
—
OH
05
—
64258809
—
KY
01
—
K25580
HUMANA
—
01
—
P00206691
MEDICARE RAILROAD
—
01
—
P12034749
MULTIPLAN
—
Enumeration date
11/30/2006
Last updated
12/03/2020
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