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NPI Code Detail

MEDICARE: JOHN J IBANEZ PA

MEDICARE: JOHN J IBANEZ PA
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
1363A00000XPhysician AssistantPA405KY

General Provider Information

NPI Number : 1770580250
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHN J IBANEZ PA
Provider Business Mailing Address
First Line : 419 COLDSTREAM DR
Second Line :
City : DANVILLE
State : KY
Zip : 40422-1013
Country : US
Telephone Number : 859-236-6621
Fax Number : 859-238-0471
Provider Business Practice Location Address
First Line : 1101 VETERANS DR
Second Line :
City : LEXINGTON
State : KY
Zip : 40502-2235
Country : US
Telephone Number : 859-233-4511
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/30/2005
Last Update Date : 09/26/2025

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Directions to “ JOHN J IBANEZ PA” Practice Location

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