Healthcare Provider Details

I. General information

NPI: 1801839808
Provider Name (Legal Business Name): DANIEL KEITH SANFORD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 11/27/2024
Certification Date: 11/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 S 3RD ST
DANVILLE KY
40422
US

IV. Provider business mailing address

PO BOX 1080
BURKESVILLE KY
42717-1080
US

V. Phone/Fax

Practice location:
  • Phone: 859-236-7712
  • Fax: 270-858-4607
Mailing address:
  • Phone: 270-858-6655
  • Fax: 270-858-4027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number036108680
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number30958
License Number StateMS
# 3
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number36597
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: