Healthcare Provider Details

I. General information

NPI: 1669784609
Provider Name (Legal Business Name): GREGORY LUTHER REPASS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2010
Last Update Date: 12/08/2020
Certification Date: 12/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1740 NICHOLASVILLE RD
LEXINGTON KY
40503-1431
US

IV. Provider business mailing address

1740 NICHOLASVILLE RD
LEXINGTON KY
40503-1431
US

V. Phone/Fax

Practice location:
  • Phone: 859-260-6100
  • Fax:
Mailing address:
  • Phone: 859-260-6100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number46223
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME110637
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: