Provider Demographics
NPI:1629082565
Name:VIOLETTE, JEFFREY (DO)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:VIOLETTE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1792 ALYSHEBA WAY
Mailing Address - Street 2:SUITE 150
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-2288
Mailing Address - Country:US
Mailing Address - Phone:859-335-9041
Mailing Address - Fax:859-335-9072
Practice Address - Street 1:1792 ALYSHEBA WAY
Practice Address - Street 2:SUITE 150
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-2288
Practice Address - Country:US
Practice Address - Phone:859-335-9041
Practice Address - Fax:859-335-9072
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2012-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY02860207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000338914OtherANTHEM
KYP00220271OtherRR-MEDICARE
WV3000137OtherBWC
WV3810004553Medicaid
KY64039522Medicaid
KY50005452OtherPASSPORT
VA010177618Medicaid
VA010177618Medicaid
WV3810004553Medicaid
KYH49549Medicare UPIN