Provider Demographics
NPI:1609965375
Name:QUERUBIN, JESUS PRESTO JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JESUS
Middle Name:PRESTO
Last Name:QUERUBIN
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 828
Mailing Address - Street 2:
Mailing Address - City:GREENUP
Mailing Address - State:KY
Mailing Address - Zip Code:41144-1074
Mailing Address - Country:US
Mailing Address - Phone:606-473-1501
Mailing Address - Fax:606-473-1503
Practice Address - Street 1:401 US 23
Practice Address - Street 2:
Practice Address - City:GREENUP
Practice Address - State:KY
Practice Address - Zip Code:41144-1074
Practice Address - Country:US
Practice Address - Phone:606-473-1501
Practice Address - Fax:606-473-1503
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2015-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY33412207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2017990Medicaid
P00060046OtherRR MEDICARE
KY64332141Medicaid
P00060046OtherRR MEDICARE
G67000Medicare UPIN