Healthcare Provider Details

I. General information

NPI: 1063497113
Provider Name (Legal Business Name): RAYMOND WECHMAN JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2005
Last Update Date: 02/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1138 LEXINGTON RD STE 130
GEORGETOWN KY
40324-9672
US

IV. Provider business mailing address

1138 LEXINGTON RD STE 130
GEORGETOWN KY
40324-9672
US

V. Phone/Fax

Practice location:
  • Phone: 502-867-0222
  • Fax: 502-867-0420
Mailing address:
  • Phone: 502-867-0222
  • Fax: 502-867-0420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25343
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: