Provider Demographics
NPI:1699989640
Name:DEVERS, DUSTIN K (DO)
Entity type:Individual
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First Name:DUSTIN
Middle Name:K
Last Name:DEVERS
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Gender:M
Credentials:DO
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Mailing Address - Street 1:230 LEXINGTON GREEN CIR
Mailing Address - Street 2:STE 600
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-3326
Mailing Address - Country:US
Mailing Address - Phone:859-971-4695
Mailing Address - Fax:859-971-4604
Practice Address - Street 1:713 BROADWAY ST
Practice Address - Street 2:SUITE 202
Practice Address - City:PAINTSVILLE
Practice Address - State:KY
Practice Address - Zip Code:41240-1465
Practice Address - Country:US
Practice Address - Phone:606-789-6632
Practice Address - Fax:606-886-9908
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2020-12-03
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Provider Licenses
StateLicense IDTaxonomies
KY03031207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100016250Medicaid
KY9632Medicare PIN