Provider Demographics
NPI:1003911546
Name:BEHNKE, ERNEST EDMUND JR (MD)
Entity type:Individual
Prefix:DR
First Name:ERNEST
Middle Name:EDMUND
Last Name:BEHNKE
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ERNEST
Other - Middle Name:
Other - Last Name:BEHNKE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2401 FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41101-3732
Mailing Address - Country:US
Mailing Address - Phone:606-324-6659
Mailing Address - Fax:
Practice Address - Street 1:2401 FOREST AVE
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-3732
Practice Address - Country:US
Practice Address - Phone:606-571-3563
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2014-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY22279207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64222797Medicaid
MS041000221Medicare PIN
MS$$$$$$$$$OtherBLUE CROSS