Individual
JASON K FOGG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1305 N ELM ST, HENDERSON, KY 42420-2783
(270) 957-8800
(270) 957-8797
Mailing address
1305 N ELM ST, HENDERSON, KY 42420-2783
(709) 578-8002
(270) 957-8797
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
OT012163
PA
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
Primary
03504
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100205830
—
KY
Enumeration date
02/10/2009
Last updated
11/05/2020
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