Basic Information
| Provider Information | |||||||||
| NPI: | 1659318855 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DEMPSEY | ||||||||
| FirstName: | JERRY | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2300 CHAMBER CENTER DR | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | LAKESIDE PARK | ||||||||
| State: | KY | ||||||||
| PostalCode: | 410171686 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8597814111 | ||||||||
| FaxNumber: | 8594415214 | ||||||||
| Practice Location | |||||||||
| Address1: | 125 ST. MICHAEL DRIVE | ||||||||
| Address2: | |||||||||
| City: | COLD SPRING | ||||||||
| State: | KY | ||||||||
| PostalCode: | 410769999 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8597814111 | ||||||||
| FaxNumber: | 8594415214 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/31/2006 | ||||||||
| LastUpdateDate: | 11/11/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 17999 | KY | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 6417999 | 05 | KY | MEDICAID | 0498162 | 05 | OH | MEDICAID | P00828059 | 01 | KY | RAILROAD MEDICARE | OTHER | 080092533 | 01 | KY | RAILROAD MEDICARE | OTHER |