Provider Demographics
NPI:1174986046
Name:WEHRY, JOHN
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:WEHRY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2307 S HIGHWAY 53
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:KY
Mailing Address - Zip Code:40031-8568
Mailing Address - Country:US
Mailing Address - Phone:502-225-6277
Mailing Address - Fax:502-225-6278
Practice Address - Street 1:2307 S HIGHWAY 53
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:KY
Practice Address - Zip Code:40031-8568
Practice Address - Country:US
Practice Address - Phone:502-225-6277
Practice Address - Fax:502-225-6278
Is Sole Proprietor?:No
Enumeration Date:2016-03-30
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY52711208000000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program