Provider Demographics
NPI:1265480206
Name:GEREN, JOHN W (DO)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:W
Last Name:GEREN
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 1:1621 WOODS RD
Mailing Address - Street 2:
Mailing Address - City:NICHOLASVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40356-8790
Mailing Address - Country:US
Mailing Address - Phone:859-619-8295
Mailing Address - Fax:
Practice Address - Street 1:210 E WALNUT ST
Practice Address - Street 2:
Practice Address - City:NICHOLASVILLE
Practice Address - State:KY
Practice Address - Zip Code:40356-1252
Practice Address - Country:US
Practice Address - Phone:859-225-4325
Practice Address - Fax:859-225-0458
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2015-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY02075207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYC66833Medicare UPIN
KY0245103Medicare ID - Type Unspecified