Provider Demographics
NPI:1669494613
Name:LEA, GERALD ALLAN (MD)
Entity Type:Individual
Prefix:MR
First Name:GERALD
Middle Name:ALLAN
Last Name:LEA
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 1:6907 BURLINGTON PIKE
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41042
Mailing Address - Country:US
Mailing Address - Phone:859-525-1846
Mailing Address - Fax:859-647-3355
Practice Address - Street 1:6907 BURLINGTON PIKE
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042
Practice Address - Country:US
Practice Address - Phone:859-525-1846
Practice Address - Fax:859-647-3355
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2012-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY21313207V00000X
OH35048903207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0068362Medicaid
KY64213135Medicaid
OH0068362Medicaid
KYK058750Medicare PIN
KYC69299Medicare UPIN