Provider Demographics
NPI:1215939855
Name:SEGAL, JAMES E (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:E
Last Name:SEGAL
Suffix:
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 1:2700 STANLEY GAULT PKWY STE 129
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-5176
Mailing Address - Country:US
Mailing Address - Phone:502-489-6613
Mailing Address - Fax:502-489-5751
Practice Address - Street 1:950 BRECKENRIDGE LN STE 200
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-5929
Practice Address - Country:US
Practice Address - Phone:502-893-6777
Practice Address - Fax:502-899-5535
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2020-12-02
Deactivation Date:2006-03-22
Deactivation Code:
Reactivation Date:2006-04-07
Provider Licenses
StateLicense IDTaxonomies
KY29732207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYP00969812OtherMEDICARE RR
KY64297328Medicaid
000000190952OtherANTHEM
50000109OtherPASSPORT
KY64297328Medicaid
50000109OtherPASSPORT
G12126Medicare UPIN
160059717Medicare PIN