Individual
DR. JOHN A DACOSTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
800 HOSPITAL DR, MADISONVILLE, KY 42431-1658
(270) 326-5000
Mailing address
200 CLINIC DR, MADISONVILLE, KY 42431-1661
(270) 326-5000
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
25MA06013400
NJ
207RG0100X
Gastroenterology Physician
Primary
40483
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000492749
BCBS PROVIDER NUMBER
KY
05
—
64124571
—
KY
05
—
6968708
—
NJ
Enumeration date
07/10/2006
Last updated
12/03/2020
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