Healthcare Provider Details

I. General information

NPI: 1053339119
Provider Name (Legal Business Name): JAMES STORMER PEZZI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 04/05/2021
Certification Date: 04/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1780 NICHOLASVILLE RD STE 202
LEXINGTON KY
40503-1412
US

IV. Provider business mailing address

1401 HARRODSBURG RD STE B355
LEXINGTON KY
40504-3747
US

V. Phone/Fax

Practice location:
  • Phone: 859-260-5051
  • Fax:
Mailing address:
  • Phone: 859-276-5262
  • Fax: 859-277-6509

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number31658
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: