Provider Demographics
NPI:1659393700
Name:SIZEMORE, STANLEY W (MD)
Entity Type:Individual
Prefix:
First Name:STANLEY
Middle Name:W
Last Name:SIZEMORE
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 1:1306 VERSAILLES RD
Mailing Address - Street 2:STE 120
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40504-1796
Mailing Address - Country:US
Mailing Address - Phone:859-259-2635
Mailing Address - Fax:859-254-7874
Practice Address - Street 1:1306 VERSAILLES RD
Practice Address - Street 2:STE 120
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-1796
Practice Address - Country:US
Practice Address - Phone:859-259-2635
Practice Address - Fax:859-254-7874
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2020-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY29975207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64299753Medicaid
KYK075280Medicare PIN
KYK075281Medicare UPIN
KY64299753Medicaid