1528078367

Everything you always wanted to know about BORDERS KENNETH JOHN (JACK) JR. M.D. but were afraid to ask.

BORDERS KENNETH JOHN (JACK) JR. M.D.

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Provider Last Name Provider Middle Name Provider First Name Provider Suffix Provider Credential
BORDERS KENNETH JOHN (JACK) JR. M.D.
Gender:
Male
Enumeration date:
2006-08-08
Last update date:
2007-07-08
Current as of:
Is sole proprietor?:
No
Is organization subpart?:
No
In PECOS?:
Yes
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Identifiers

identifier description issuer state
D33263 Medicare UPIN none KY
64764996 Medicaid none KY
000000050360 Other ANTHEM 12 DIGIT NUMBER none
0413047 Medicaid none OH
0296201 Medicare ID-Type Undpecified none KY

Taxonomies

Taxonomy State License Number Primary?
2084N0402X Neurology with Special Qualifications in Child Neurology KY 21774

Phone Numbers

Type Number
Mailing Address Telephone Number 6063260322
Practice Location Address Telephone Number 6063260322
Mailing Address Fax Number 6063269809
Practice Location Address Fax Number 6063269809

Addresses

Type Address City State Postal Country
Mailing Address 2000 ASHLAND DR ASHLAND KY 41101 KY
Practice Location Address 2000 ASHLAND DR P.O. BOX 1447 ASHLAND KY 41101 KY

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NPI Name Address State City
1467462101 LANCE, SCOTT
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2000 ASHLAND DR KY ASHLAND