Provider Demographics
NPI:1548266026
Name:DEMOS, JON STANLEY (MD)
Entity type:Individual
Prefix:DR
First Name:JON
Middle Name:STANLEY
Last Name:DEMOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1101 VETERANS DR.
Mailing Address - Street 2:RM A509A -CDD, DEPT. OF VETERANS AFFAIRS,
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40502-2236
Mailing Address - Country:US
Mailing Address - Phone:859-281-4964
Mailing Address - Fax:859-381-5824
Practice Address - Street 1:1101 VETERANS DR
Practice Address - Street 2:RM A509A-CDD
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40502-2235
Practice Address - Country:US
Practice Address - Phone:859-281-4964
Practice Address - Fax:859-381-5824
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY21889208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64218894Medicaid
KY340005024Medicare PIN
KYC73536Medicare UPIN
KY1275605Medicare PIN
KY0992203Medicare PIN