Provider Demographics
NPI:1215930466
Name:DINKINS, JUAN S (DO)
Entity type:Individual
Prefix:DR
First Name:JUAN
Middle Name:S
Last Name:DINKINS
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 1:127 CRESTVIEW PARK DR
Mailing Address - Street 2:
Mailing Address - City:DICKSON
Mailing Address - State:TN
Mailing Address - Zip Code:37055-2850
Mailing Address - Country:US
Mailing Address - Phone:615-446-5121
Mailing Address - Fax:615-446-1357
Practice Address - Street 1:127 CRESTVIEW PARK DR
Practice Address - Street 2:
Practice Address - City:DICKSON
Practice Address - State:TN
Practice Address - Zip Code:37055-2850
Practice Address - Country:US
Practice Address - Phone:615-441-4510
Practice Address - Fax:615-446-1357
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDO1635207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00203737OtherRAILROAD MEDICARE PIN
TN3114072Medicaid
TN4096537OtherBLUE CROSS BLUE SHIELD TN
TN4096537OtherBLUE CROSS BLUE SHIELD TN
3304804Medicare PIN