Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | 31658 | KY |
NPI | 1053339119 |
---|---|
Provider Name | Dr. James Stormer Pezzi |
First Address | Lexington, KY 40504-3747 |
Second Address | Lexington, KY 40503-1412 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2006 |
Last Update Date | 05/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000052183 | ANTHEM BCBS (01) | KY |
100012473 | RAILROAD MEDICARE (01) | KY |
1096664 | WELLCARE OF KY (MEDICAID) (01) | KY |
1163061 | CIGNA (01) | KY |
1196008 | CHA (01) | KY |
2900003 | UNITED HEALTHCARE (01) | KY |
4493038 | AETNA (01) | KY |
64316581 | (05) | KY |
C23033 | CUMBERLAND HEALTH (01) | KY |
F45502 | (02) | KY |