Provider Demographics
NPI:1003808783
Name:YEZERSKI, JOHN A (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:A
Last Name:YEZERSKI
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 1:300 S 8TH ST
Mailing Address - Street 2:SUITE 480W
Mailing Address - City:MURRAY
Mailing Address - State:KY
Mailing Address - Zip Code:42071-2444
Mailing Address - Country:US
Mailing Address - Phone:270-759-1444
Mailing Address - Fax:270-752-2856
Practice Address - Street 1:300 S 8TH ST
Practice Address - Street 2:SUITE 178W
Practice Address - City:MURRAY
Practice Address - State:KY
Practice Address - Zip Code:42071-2444
Practice Address - Country:US
Practice Address - Phone:270-759-1444
Practice Address - Fax:270-752-2856
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY22751207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64227515Medicaid
KYK149750Medicare PIN
KY90150186Medicaid
KY000000048910OtherANTHEM
0606501Medicare PIN
KYC73272Medicare UPIN