Jeffrey W Dickerson MD LLC

Primary specialty

Pulmonary Disease PhysicianTaxonomy code 207RP1001X

Legal business name

JEFFREY W DICKERSON MD LLC

Practice address

991 Medical Park Drive
Suite 202
Maysville, KY 41056

Phone

(606) 759-8000

Fax

(606) 759-0461

NPI assigned

Nov 2, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Jeffrey W Dickerson, MD

Title

Owner

Phone

(606) 759-8000

Specialties & licenses 2

Addresses

Other identifiers 8

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1193961600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1237334400000",
    "number": "1942489299",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "991 MEDICAL PARK DRIVE",
            "address_2": "SUITE 202",
            "city": "MAYSVILLE",
            "state": "KY",
            "postal_code": "41056",
            "telephone_number": "606-759-8000",
            "fax_number": "606-759-0461"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "991 MEDICAL PARK DRIVE",
            "address_2": "SUITE 202",
            "city": "MAYSVILLE",
            "state": "KY",
            "postal_code": "41056",
            "telephone_number": "606-759-8000",
            "fax_number": "606-759-0461"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEFFREY W DICKERSON MD LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-02",
        "last_updated": "2009-03-18",
        "status": "A",
        "authorized_official_last_name": "DICKERSON",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "606-759-8000",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RP1001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207RS0012X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Internal Medicine, Sleep Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MULTIPLAN",
            "identifier": "P12034749",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CHA",
            "identifier": "1210239",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000322098",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL NPI",
            "identifier": "1346317575",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HUMANA",
            "identifier": "K25580",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2473210",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P00206691",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "64258809",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Shannon Irish
• Bethany Dawn Jack
• Jasmine Jackson
• James E Adams DMD Inc
• Barbara Kay Jefferson, PHD
• Blake Jenkins, LDO
• Rae Jean Jessee, APRN
• Amanda Johnson
• Heather Jolly
• Autumn Jones, CSW

• Pulmonary Disease Physician in Maysville, KY
• Providers in Maysville, KY by specialty
• Pulmonary Disease Physician in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.