Healthcare Provider Details

I. General information

NPI: 1831167071
Provider Name (Legal Business Name): MONTY S METCALFE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 03/07/2023
Certification Date: 01/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 BOB O LINK DR SUITE 100
LEXINGTON KY
40504-3759
US

IV. Provider business mailing address

PO BOX 936
LONDON KY
40743-0936
US

V. Phone/Fax

Practice location:
  • Phone: 859-224-3194
  • Fax: 859-219-3304
Mailing address:
  • Phone: 606-330-7818
  • Fax: 606-330-7825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number20208
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: