Provider Demographics
NPI:1558322966
Name:PRICE, JOHN ROGERS (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:ROGERS
Last Name:PRICE
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 1080
Mailing Address - Street 2:
Mailing Address - City:BURKESVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42717-1080
Mailing Address - Country:US
Mailing Address - Phone:270-864-1472
Mailing Address - Fax:270-864-1693
Practice Address - Street 1:376 RANDOLPH ST
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:KY
Practice Address - Zip Code:42539-3382
Practice Address - Country:US
Practice Address - Phone:606-787-6246
Practice Address - Fax:606-787-6248
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2014-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY17903207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64179039Medicaid
KYC70975Medicare UPIN
KY64179039Medicaid
KYC70975Medicare UPIN
KY96390230001OtherCIGNA
KY1168801Medicare ID - Type Unspecified