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General NPI Number Information
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NPI Number | 1770580250
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Entity Type | Individual
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Provider Name | JOHN J IBANEZ PA
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Gender | Male
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Dates
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Enumeration Date | 06/30/2005
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Last Update Date | 09/26/2025
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Provider Practice Location Address
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Address Line | 1101 VETERANS DR
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City | LEXINGTON
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State | KY
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Zip | 40502-2235
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Country | US
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Telephone | 859-233-4511
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Fax |
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Provider Business Mailing Address
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Address Line | 419 COLDSTREAM DR
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City | DANVILLE
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State | KY
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Zip | 40422-1013
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Country | US
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Telephone | 859-236-6621
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Fax | 859-238-0471
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA405
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License Number State | KY
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