Healthcare Provider Details

I. General information

NPI: 1750360525
Provider Name (Legal Business Name): JOSEPH A. ISAAC P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2006
Last Update Date: 02/13/2025
Certification Date: 02/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 JAMES S. TRIMBLE BLVD.
PAINTSVILLE KY
41240-1055
US

IV. Provider business mailing address

PO BOX 409013
ATLANTA GA
30384-9013
US

V. Phone/Fax

Practice location:
  • Phone: 606-789-3511
  • Fax: 606-789-1432
Mailing address:
  • Phone: 800-377-8721
  • Fax: 304-523-2241

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA 616
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: