Basic Information
Provider Information
NPI: 1720548563
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CONWELL
FirstName: JAMES
MiddleName: ALLEN
NamePrefix:  
NameSuffix:  
Credential: DO
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 800 ROSE STREET ANESTHESIOLOGY
Address2:  
City: LEXINGTON
State: KY
PostalCode: 405360293
CountryCode: US
TelephoneNumber: 8592180069
FaxNumber: 8593231080
Practice Location
Address1: 800 ROSE STREET ANESTHESIOLOGY
Address2:  
City: LEXINGTON
State: KY
PostalCode: 405360293
CountryCode: US
TelephoneNumber: 8592180069
FaxNumber: 8593231080
Other Information
ProviderEnumerationDate: 03/20/2019
LastUpdateDate: 07/01/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 07/01/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207L00000XR5008KYY Allopathic & Osteopathic PhysiciansAnesthesiology 

No ID Information.


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