Basic Information
| Provider Information | |||||||||
| NPI: | 1366568651 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GASTROENTEROLOGY CONSULTANTS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1720 NICHOLASVILLE ROAD | ||||||||
| Address2: | SUITE 302 | ||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 405031404 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8592764382 | ||||||||
| FaxNumber: | 8592780692 | ||||||||
| Practice Location | |||||||||
| Address1: | 1720 NICHOLASVILLE ROAD | ||||||||
| Address2: | SUITE 302 | ||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 405031404 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8592764382 | ||||||||
| FaxNumber: | 8592780692 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/21/2007 | ||||||||
| LastUpdateDate: | 05/26/2011 | ||||||||
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| AuthorizedOfficialLastName: | YON | ||||||||
| AuthorizedOfficialFirstName: | JERRY | ||||||||
| AuthorizedOfficialMiddleName: | L. | ||||||||
| AuthorizedOfficialTitleorPosition: | PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 8592764382 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | KY | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | 000000060642 | 01 | KY | ANTHEM | OTHER | J4220 | 01 | KY | RAILROAD | OTHER |