Provider Demographics
NPI:1447243167
Name:PENCE, HOBERT L (MD)
Entity type:Individual
Prefix:DR
First Name:HOBERT
Middle Name:L
Last Name:PENCE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2469
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40201-2469
Mailing Address - Country:US
Mailing Address - Phone:502-852-8509
Mailing Address - Fax:
Practice Address - Street 1:210 E GRAY ST
Practice Address - Street 2:STE 1000
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-3906
Practice Address - Country:US
Practice Address - Phone:502-629-3320
Practice Address - Fax:502-629-3975
Is Sole Proprietor?:No
Enumeration Date:2005-08-29
Last Update Date:2010-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY18134207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100350340Medicaid
KY64181340Medicaid
KYC64978Medicare UPIN
IN100350340Medicaid