MEDICARE: DR. JAMES STORMER PEZZI M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0100X	Gastroenterology Physician	31658	KY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	100012473	OTHER	KY	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	4493038	OTHER	KY	AETNA
4	C23033	OTHER	KY	CUMBERLAND HEALTH
5	1196008	OTHER	KY	CHA
6	2900003	OTHER	KY	UNITED HEALTHCARE
7	000000052183	OTHER	KY	ANTHEM BCBS
8	1163061	OTHER	KY	CIGNA
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053339119
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES STORMER PEZZI M.D.

Provider Business Mailing Address
First Line	:	1401 HARRODSBURG RD STE B355
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40504-3747
Country	:	US
Telephone Number	:	859-276-5262
Fax Number	:	859-277-6509

Provider Business Practice Location Address
First Line	:	1780 NICHOLASVILLE RD STE 202
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40503-1412
Country	:	US
Telephone Number	:	859-260-5051
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/17/2006
Last Update Date	:	04/05/2021

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Directions to “ DR. JAMES STORMER PEZZI M.D.” Practice Location

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