Provider Demographics
NPI:1447347042
Name:EDENS, CURTIS DENVER JR (DO)
Entity type:Individual
Prefix:MR
First Name:CURTIS
Middle Name:DENVER
Last Name:EDENS
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 567
Mailing Address - Street 2:
Mailing Address - City:LOUISA
Mailing Address - State:KY
Mailing Address - Zip Code:41230
Mailing Address - Country:US
Mailing Address - Phone:606-638-4900
Mailing Address - Fax:606-638-4950
Practice Address - Street 1:108 W MADISON STREET
Practice Address - Street 2:
Practice Address - City:LOUISA
Practice Address - State:KY
Practice Address - Zip Code:41230
Practice Address - Country:US
Practice Address - Phone:606-638-4900
Practice Address - Fax:606-638-4950
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY02610207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV6200062000Medicaid
KY64990369Medicaid
KY1801601Medicare ID - Type Unspecified
KY64990369Medicaid