Individual
MR. JEROME P. LACY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
6420 DUTCHMANS PKWY, SUITE 200, LOUISVILLE, KY 40205-3372
(502) 891-8300
(502) 891-8338
Mailing address
PO BOX 950232, LOUISVILLE, KY 40295-0232
(502) 891-8300
(502) 891-8338
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
15898
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000044915
ANTHEM PIN
KY
05
—
100388580A
—
IN
05
—
100388580F
—
IN
01
—
1056116
PASSPORT
KY
01
—
2433840000
PASSPORT ADVANTAGE PIN
KY
01
—
4012633
AETNA- CTS
KY
01
—
50032166
PASSPORT- CTS
KY
05
—
64158983
—
KY
Enumeration date
05/23/2006
Last updated
02/24/2015
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