Healthcare Provider Details

I. General information

NPI: 1699092510
Provider Name (Legal Business Name): JOHN M MCCURDY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2010
Last Update Date: 08/09/2024
Certification Date: 08/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 TAYLOR BLVD
LOUISVILLE KY
40215-2342
US

IV. Provider business mailing address

PO BOX 950244
LOUISVILLE KY
40295-0244
US

V. Phone/Fax

Practice location:
  • Phone: 502-366-4747
  • Fax: 502-996-8309
Mailing address:
  • Phone: 502-953-4700
  • Fax: 502-772-8189

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number46258
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number46258
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: