Provider Demographics
NPI:1609984475
Name:GILLESPIE, JOHN PAUL (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:PAUL
Last Name:GILLESPIE
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 1:2013 MERCHANT DR STE 3
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-6856
Mailing Address - Country:US
Mailing Address - Phone:859-624-2290
Mailing Address - Fax:859-624-5455
Practice Address - Street 1:2013 MERCHANT DR STE 3
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-6856
Practice Address - Country:US
Practice Address - Phone:859-624-2290
Practice Address - Fax:859-624-5455
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY23451207R00000X, 207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64234511Medicaid
KY000000048340OtherANTHEM
KY000000048340OtherANTHEM
110023211OtherRAILROAD MEDICARE
C74993Medicare UPIN
KY1385901Medicare PIN