Provider Demographics
NPI:1922134956
Name:COST, GUINN SHAW JR (MD)
Entity Type:Individual
Prefix:
First Name:GUINN
Middle Name:SHAW
Last Name:COST
Suffix:JR
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 1:132 SARA'S LANE
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42345
Mailing Address - Country:US
Mailing Address - Phone:270-338-5297
Mailing Address - Fax:
Practice Address - Street 1:132 SARA'S LANE
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:KY
Practice Address - Zip Code:42345
Practice Address - Country:US
Practice Address - Phone:270-338-5297
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY16776207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYC67436Medicare UPIN