Provider Demographics
NPI:1629456207
Name:MOJESKY, COLTON DANIEL
Entity Type:Individual
Prefix:
First Name:COLTON
Middle Name:DANIEL
Last Name:MOJESKY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:479 LAKETOWER DR APT 307
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40502-2666
Mailing Address - Country:US
Mailing Address - Phone:859-516-1994
Mailing Address - Fax:
Practice Address - Street 1:4960 NORTON HEALTHCARE BLVD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40241-2831
Practice Address - Country:US
Practice Address - Phone:859-516-1994
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-14
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC210168207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology