Provider Demographics
NPI:1609907641
Name:YORK, PAUL SANDIDGE JR (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:SANDIDGE
Last Name:YORK
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2190 N JACKSON HWY
Mailing Address - Street 2:
Mailing Address - City:GLASGOW
Mailing Address - State:KY
Mailing Address - Zip Code:42141-9096
Mailing Address - Country:US
Mailing Address - Phone:270-651-8117
Mailing Address - Fax:
Practice Address - Street 1:2190 N JACKSON HWY
Practice Address - Street 2:
Practice Address - City:GLASGOW
Practice Address - State:KY
Practice Address - Zip Code:42141-9096
Practice Address - Country:US
Practice Address - Phone:270-651-8117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY17529208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
00304552OtherAUA #
KY17529OtherSTATE MEDICAL LICENSE
KYAY618048OtherDEA #