Organization
JEFFREY W DICKERSON MD LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JEFFREY W DICKERSON MD (OWNER)
(606) 759-8000
Entity
Organization
Contact information
Practice address
991 MEDICAL PARK DRIVE, SUITE 202, MAYSVILLE, KY 41056
(606) 759-8000
(606) 759-0461
Mailing address
991 MEDICAL PARK DRIVE, SUITE 202, MAYSVILLE, KY 41056
(606) 759-8000
(606) 759-0461
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
—
—
207RS0012X
Sleep Medicine (Internal Medicine) Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000322098
ANTHEM
KY
01
—
1210239
CHA
KY
01
—
1346317575
INDIVIDUAL NPI
—
05
—
2473210
—
OH
05
—
64258809
—
KY
01
—
K25580
HUMANA
KY
01
—
P00206691
RR MEDICARE
KY
01
—
P12034749
MULTIPLAN
KY
Enumeration date
11/02/2007
Last updated
03/18/2009
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