Provider Demographics
NPI:1477859635
Name:SEGO, JOSEPH D (PA)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:D
Last Name:SEGO
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2119
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42702-2119
Mailing Address - Country:US
Mailing Address - Phone:270-735-1588
Mailing Address - Fax:270-735-1589
Practice Address - Street 1:2407 RING RD STE 108
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-5938
Practice Address - Country:US
Practice Address - Phone:270-735-1588
Practice Address - Fax:270-735-1589
Is Sole Proprietor?:No
Enumeration Date:2011-02-07
Last Update Date:2014-06-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KYPA1627363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100100480Medicaid