Provider Demographics
NPI:1053339119
Name:PEZZI, JAMES STORMER (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:STORMER
Last Name:PEZZI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1401 HARRODSBURG RD STE B355
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40504-3747
Mailing Address - Country:US
Mailing Address - Phone:859-276-5262
Mailing Address - Fax:859-277-6509
Practice Address - Street 1:1780 NICHOLASVILLE RD STE 202
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-1412
Practice Address - Country:US
Practice Address - Phone:859-260-5051
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY31658207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1096664OtherWELLCARE OF KY (MEDICAID)
KY4493038OtherAETNA
KY100012473OtherRAILROAD MEDICARE
KYC23033OtherCUMBERLAND HEALTH
KY1196008OtherCHA
KY2900003OtherUNITED HEALTHCARE
KY000000052183OtherANTHEM BCBS
KY1163061OtherCIGNA
KY64316581Medicaid
KYC23033OtherCUMBERLAND HEALTH
KY64316581Medicaid