Individual
MR. JUSTIN CLAY PENTICUFF
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
810 CHERYL LN, LEXINGTON, KY 40504-2318
(859) 749-0248
Mailing address
810 CHERYL LN, LEXINGTON, KY 40504-2318
(859) 749-0248
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
55255
KY
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/07/2015
Last updated
07/06/2021
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