Provider Demographics
NPI:1861442923
Name:SANCHEZ, JON (MD)
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:
Last Name:SANCHEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 AMSDEN AVE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:VERSAILLES
Mailing Address - State:KY
Mailing Address - Zip Code:40383-1851
Mailing Address - Country:US
Mailing Address - Phone:859-873-2113
Mailing Address - Fax:859-873-2114
Practice Address - Street 1:360 AMSDEN AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:VERSAILLES
Practice Address - State:KY
Practice Address - Zip Code:40383-1851
Practice Address - Country:US
Practice Address - Phone:859-873-2113
Practice Address - Fax:859-873-2114
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY22856207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64111453Medicaid
KYA13960Medicare UPIN
KY64111453Medicaid