Provider Demographics
NPI:1407068224
Name:BISSET, GUY B (CPED)
Entity Type:Individual
Prefix:
First Name:GUY
Middle Name:B
Last Name:BISSET
Suffix:
Gender:M
Credentials:CPED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 S ASHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40502-1976
Mailing Address - Country:US
Mailing Address - Phone:859-266-0420
Mailing Address - Fax:859-266-0667
Practice Address - Street 1:312 S ASHLAND AVE
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40502-1976
Practice Address - Country:US
Practice Address - Phone:859-266-0420
Practice Address - Fax:859-266-0667
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2009-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes211D00000XPodiatric Medicine & Surgery Service ProvidersAssistant, Podiatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY74928OtherUNITED HEALTHCARE
KY5574649OtherAETNA
KY7100026770Medicaid
KY000000519294OtherANTHEM CB/BS
KY208278527OtherHUMANA
KY5574649OtherAETNA
KY5939230001Medicare NSC