Provider Demographics
NPI:1740279405
Name:WESTERFIELD, JERRY DUKE (RADIOLOGISTS)
Entity type:Individual
Prefix:DR
First Name:JERRY
Middle Name:DUKE
Last Name:WESTERFIELD
Suffix:
Gender:M
Credentials:RADIOLOGISTS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 DOWELL RD
Mailing Address - Street 2:
Mailing Address - City:RUSSELL SPRINGS
Mailing Address - State:KY
Mailing Address - Zip Code:42642-4236
Mailing Address - Country:US
Mailing Address - Phone:270-866-4868
Mailing Address - Fax:270-866-4809
Practice Address - Street 1:43 DOWELL RD
Practice Address - Street 2:
Practice Address - City:RUSSELL SPRINGS
Practice Address - State:KY
Practice Address - Zip Code:42642-4236
Practice Address - Country:US
Practice Address - Phone:270-866-4868
Practice Address - Fax:270-866-4809
Is Sole Proprietor?:No
Enumeration Date:2005-10-17
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY148792085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64046212Medicaid
KYP00222067Medicare PIN
KY0904801Medicare PIN
KYP00099502Medicare PIN
KY0916701Medicare PIN
KY64046212Medicaid