Provider Demographics
NPI:1407111974
Name:BUDHAN, JEROME EDWARD RASHEED (MD)
Entity Type:Individual
Prefix:DR
First Name:JEROME
Middle Name:EDWARD RASHEED
Last Name:BUDHAN
Suffix:
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 1:223 BURLEY AVE
Mailing Address - Street 2:
Mailing Address - City:HOPKINSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42240-8725
Mailing Address - Country:US
Mailing Address - Phone:270-887-6575
Mailing Address - Fax:
Practice Address - Street 1:223 BURLEY AVE
Practice Address - Street 2:
Practice Address - City:HOPKINSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42240-8725
Practice Address - Country:US
Practice Address - Phone:270-887-6575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-10
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
KY47853207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program