Provider Demographics
NPI:1457387292
Name:PUNZAL, EMILIO JR (MD)
Entity type:Individual
Prefix:
First Name:EMILIO
Middle Name:
Last Name:PUNZAL
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 1:1000 ST CHRISTOPHER
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41101
Mailing Address - Country:US
Mailing Address - Phone:606-833-3333
Mailing Address - Fax:
Practice Address - Street 1:2201 LEXINGTON AVE
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-2843
Practice Address - Country:US
Practice Address - Phone:606-408-4000
Practice Address - Fax:606-408-6625
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY37456208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000478439OtherANTHEM BCBS
KY64056716Medicaid
KY000000577949OtherANTHEM BCBS
KY0641225Medicare PIN
KY000000577949OtherANTHEM BCBS
KY0782201Medicare PIN
KY3400062Medicare PIN
KY00749001Medicare PIN
KY180036Medicare Oscar/Certification