Healthcare Provider Details

I. General information

NPI: 1023218542
Provider Name (Legal Business Name): JUSTIN KIRBY WAINSCOTT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2007
Last Update Date: 07/23/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 ROSE ST
LEXINGTON KY
40536-0293
US

IV. Provider business mailing address

2333 ALUMNI PARK PLZ STE 200
LEXINGTON KY
40517-4022
US

V. Phone/Fax

Practice location:
  • Phone: 859-323-5956
  • Fax: 859-323-1080
Mailing address:
  • Phone: 859-218-5677
  • Fax: 859-257-7899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number40752
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: