Healthcare Provider Details

I. General information

NPI: 1881804441
Provider Name (Legal Business Name): PATRICK J SEREY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 11/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 CONN TER
LEXINGTON KY
40508-3206
US

IV. Provider business mailing address

1900 RICHMOND RD
LEXINGTON KY
40502-1204
US

V. Phone/Fax

Practice location:
  • Phone: 859-266-2101
  • Fax: 859-268-5636
Mailing address:
  • Phone: 859-266-2101
  • Fax: 859-268-5636

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License Number13948
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: