Provider Demographics
NPI:1245394246
Name:DENNISON, ROBERT RUSSELL JR (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:RUSSELL
Last Name:DENNISON
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3439 BUCKHORN DRIVE
Mailing Address - Street 2:SUITE 160
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40515
Mailing Address - Country:US
Mailing Address - Phone:859-368-8820
Mailing Address - Fax:
Practice Address - Street 1:108 HIDDEN GROVE LN
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:KY
Practice Address - Zip Code:40391-8845
Practice Address - Country:US
Practice Address - Phone:859-527-6601
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2015-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYMD16062207P00000X
KY16062207RA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYPENDINGMedicaid
KYPENDINGMedicare ID - Type Unspecified
KYPENDINGMedicaid