Provider Demographics
NPI:1619907813
Name:ARTERBERRY, JOE FRANKLIN (MD)
Entity Type:Individual
Prefix:DR
First Name:JOE
Middle Name:FRANKLIN
Last Name:ARTERBERRY
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 1:3999 DUTCHMANS LANE
Mailing Address - Street 2:SUITE LL-C
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207
Mailing Address - Country:US
Mailing Address - Phone:502-561-0412
Mailing Address - Fax:502-589-7813
Practice Address - Street 1:3999 DUTCHMANS LANE
Practice Address - Street 2:SUITE LL-C
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207
Practice Address - Country:US
Practice Address - Phone:502-561-0412
Practice Address - Fax:502-589-7801
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2020-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY19046174400000X, 207WX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0200XAllopathic & Osteopathic PhysiciansOphthalmologyOphthalmic Plastic and Reconstructive Surgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64190465Medicaid
KY1051618Medicaid
KY000000068763OtherANTHEM PROVIDER ID
IN100008690AMedicaid
KY611033826OtherTAX IDENTIFICATION NUMBER
KY000000068763OtherANTHEM PROVIDER ID
KY611033826OtherTAX IDENTIFICATION NUMBER
KYC62983Medicare UPIN
KY1051618Medicaid