Provider Demographics
NPI:1437260585
Name:JOSEPH J ZAYDON JR MD
Entity Type:Organization
Organization Name:JOSEPH J ZAYDON JR MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:BECK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-843-1100
Mailing Address - Street 1:PO BOX 9901
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42102-4901
Mailing Address - Country:US
Mailing Address - Phone:270-843-1100
Mailing Address - Fax:270-843-1113
Practice Address - Street 1:720 2ND STREET
Practice Address - Street 2:STE 302
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42101
Practice Address - Country:US
Practice Address - Phone:270-843-1100
Practice Address - Fax:270-843-1113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY225532086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64225535Medicaid
KY000000043324OtherBCBS
KY64225535Medicaid
KY1414201Medicare PIN