Healthcare Provider Details

I. General information

NPI: 1790788834
Provider Name (Legal Business Name): MICHAEL SCOTT MAYRON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 08/24/2022
Certification Date: 08/24/2022
Deactivation Date: 03/15/2006
Reactivation Date: 03/22/2006

III. Provider practice location address

6211 E. WATERFORD BLVD.
EVENSVILLE IN
47715
US

IV. Provider business mailing address

736 MORNINGSIDE DR.
HENDERSON KY
42420
US

V. Phone/Fax

Practice location:
  • Phone: 270-830-9872
  • Fax: 270-830-8332
Mailing address:
  • Phone: 270-860-1982
  • Fax: 270-830-8332

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number34437
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: