Healthcare Provider Details

I. General information

NPI: 1922219294
Provider Name (Legal Business Name): JOHN E. PAPPAS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2007
Last Update Date: 03/07/2023
Certification Date: 10/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 CHURCH ST STE 101
PIKEVILLE KY
41501-3476
US

IV. Provider business mailing address

354 WALLER AVE SUITE 110
LEXINGTON KY
40504-2928
US

V. Phone/Fax

Practice location:
  • Phone: 606-432-5660
  • Fax:
Mailing address:
  • Phone: 859-225-5672
  • Fax: 859-276-1020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number17920
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number17920
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: