Provider Demographics
NPI:1194949024
Name:EVERSOLE, JAMES E JR (MD)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:E
Last Name:EVERSOLE
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2549 DELL RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40205-2309
Mailing Address - Country:US
Mailing Address - Phone:502-454-3000
Mailing Address - Fax:
Practice Address - Street 1:200 HIGH RISE DR
Practice Address - Street 2:STE 374
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40213-3252
Practice Address - Country:US
Practice Address - Phone:502-969-6552
Practice Address - Fax:502-969-3799
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2017-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY32450207Q00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY00533022OtherMEDICARE - NORTON
KY009583OtherSIHO - NORTON
KYP00612408OtherRAILROAD MEDICARE
KY000000546227OtherANTHEM - NORTON
KY000000546227OtherANTHEM - NORTON
KY0766401Medicare ID - Type Unspecified