Provider Demographics
NPI:1053423459
Name:LAMPKIN, ROGER D JR (DP,M)
Entity type:Individual
Prefix:DR
First Name:ROGER
Middle Name:D
Last Name:LAMPKIN
Suffix:JR
Gender:M
Credentials:DP,M
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:908 B SOUTH 12TH ST
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:KY
Mailing Address - Zip Code:42071-2949
Mailing Address - Country:US
Mailing Address - Phone:270-753-0666
Mailing Address - Fax:270-753-0684
Practice Address - Street 1:908 B SOUTH 12TH ST
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:KY
Practice Address - Zip Code:42071-2949
Practice Address - Country:US
Practice Address - Phone:270-753-0666
Practice Address - Fax:270-753-0684
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY00244213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000052091OtherBLUE SHIELD
KY80002447Medicaid
KY90005646Medicaid
KY1319880003Medicare ID - Type UnspecifiedMURRAY DME
KY80002447Medicaid
KY1319880002Medicare ID - Type UnspecifiedBENTON DME
KY0583902Medicare ID - Type UnspecifiedMURRAY OFFICE
KY000000052091OtherBLUE SHIELD