Provider Demographics
NPI:1407804164
Name:PAGE', JEAN MAURICE (MD)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:MAURICE
Last Name:PAGE'
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:PO BOX 936
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40743-0936
Mailing Address - Country:US
Mailing Address - Phone:606-330-7835
Mailing Address - Fax:606-330-7825
Practice Address - Street 1:160 LONDON MOUNTAIN VIEW DR
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40741-6601
Practice Address - Country:US
Practice Address - Phone:606-864-0770
Practice Address - Fax:606-864-1461
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2019-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY34030207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64340300Medicaid
KY64340300Medicaid
KYG91397Medicare UPIN
KY64340300Medicaid