Provider Demographics
NPI:1831158393
Name:DURRETT, LENARD ROY (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:LENARD
Middle Name:ROY
Last Name:DURRETT
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 AIRPORT GARDENS RD STE 311
Mailing Address - Street 2:
Mailing Address - City:HAZARD
Mailing Address - State:KY
Mailing Address - Zip Code:41701-9529
Mailing Address - Country:US
Mailing Address - Phone:606-439-6978
Mailing Address - Fax:606-439-6927
Practice Address - Street 1:200 MEDICAL CENTER DR STE 2D
Practice Address - Street 2:
Practice Address - City:HAZARD
Practice Address - State:KY
Practice Address - Zip Code:41701-9422
Practice Address - Country:US
Practice Address - Phone:606-487-7951
Practice Address - Fax:606-487-7952
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2020-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG5008207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXMDG5008OtherWC PROVIDER NUMBER
2142031OtherAETNA PROVIDER NO
TX135482109Medicaid
TX00DA71OtherBCBS PROVIDER NUMBER
604327000OtherDEPT OF LABOR PROV NO
TX135482109Medicaid