Healthcare Provider Details

I. General information

NPI: 1326428996
Provider Name (Legal Business Name): THOMAS MAXWELL GEVEDON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2015
Last Update Date: 09/27/2024
Certification Date: 09/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 E CHESTNUT ST BLDG SUITE303
LOUISVILLE KY
40202-1831
US

IV. Provider business mailing address

1175 MATHIS FERRY RD APT J8
MOUNT PLEASANT SC
29464-5245
US

V. Phone/Fax

Practice location:
  • Phone: 502-629-5552
  • Fax: 502-629-3132
Mailing address:
  • Phone: 775-815-2848
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number51382
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: