Provider Demographics
NPI:1659318855
Name:DEMPSEY, JERRY E (MD)
Entity Type:Individual
Prefix:
First Name:JERRY
Middle Name:E
Last Name:DEMPSEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2300 CHAMBER CENTER DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:LAKESIDE PARK
Mailing Address - State:KY
Mailing Address - Zip Code:41017-1686
Mailing Address - Country:US
Mailing Address - Phone:859-781-4111
Mailing Address - Fax:859-441-5214
Practice Address - Street 1:125 ST. MICHAEL DRIVE
Practice Address - Street 2:
Practice Address - City:COLD SPRING
Practice Address - State:KY
Practice Address - Zip Code:41076-9999
Practice Address - Country:US
Practice Address - Phone:859-781-4111
Practice Address - Fax:859-441-5214
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2015-11-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY17999207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY6417999Medicaid
OH0498162Medicaid
KYP00828059OtherRAILROAD MEDICARE
KY080092533OtherRAILROAD MEDICARE
KY0387402Medicare PIN
KY008580022Medicare PIN
OH0498162Medicaid