MEDICARE: DR. PAUL SANDIDGE YORK JR. 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	208800000X	Urology Physician	17529	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00304552	OTHER		AUA #
2	17529	OTHER	KY	STATE MEDICAL LICENSE

General Provider Information

NPI Number	:	1609907641
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAUL SANDIDGE YORK JR. M.D.

Provider Business Mailing Address
First Line	:	2190 N JACKSON HWY
Second Line	:
City	:	GLASGOW
State	:	KY
Zip	:	42141-9096
Country	:	US
Telephone Number	:	270-651-8117
Fax Number	:

Provider Business Practice Location Address
First Line	:	2190 N JACKSON HWY
Second Line	:
City	:	GLASGOW
State	:	KY
Zip	:	42141-9096
Country	:	US
Telephone Number	:	270-651-8117
Fax Number	:

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

Provider Enumeration Date	:	03/09/2007
Last Update Date	:	03/07/2023

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