person
Wallace Lyle Past SR., MD
General Practice Physician in Crestwood, Kentucky
NPI 1871868802

Wallace Lyle Past SR. is a General Practice Physician based in Crestwood, KY. Wallace Lyle Past SR. practices in Crestwood, KY and has the professional credentials of MD. The NPI Number for Wallace Lyle Past SR. is 1871868802 and holds a License No. 01018231A (Kentucky).

The current practice location address for Wallace Lyle Past SR. is 4608 Heritage Manor, Crestwood, KY and can be reached out via phone at 502-614-6688 and via fax at 502-614-6688.

Location: 4608 Heritage Manor, Crestwood, KY, 40014
person
Provider Profile Details
NPI Number
1871868802
Provider Name
Wallace Lyle Past SR.
Credential
MD
Provider Entity Type
Individual
Gender
Male
Address
4608 Heritage Manor, Crestwood, KY, 40014
Phone Number
502-614-6688
Fax Number
502-614-6688
Provider Enumeration Date
03/08/2012
Last Update Date
03/09/2024
institution
Provider Business Practice Location Address Details
Address
4608 Heritage Manor
City
State
Zip
40014
Phone Number
502-614-6688
Fax Number
502-614-6688
person
Provider Business Mailing Address Details
Address
4608 Heritage Manor
City
State
Zip
40014
Phone Number
502-614-6688
Fax Number
502-614-6688
person
Provider's Taxonomy Details 1
Type
Allopathic & Osteopathic Physicians
Classification
General Practice
Speciality
-
Taxonomy
License No.
01018231A (Indiana)
Definition
Definition to come...
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