Healthcare Provider Details

I. General information

NPI: 1508933771
Provider Name (Legal Business Name): ALLEN COURTNEY HADDIX M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 12/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 VERSAILLES RD
FRANKFORT KY
40601-3857
US

IV. Provider business mailing address

601 VERSAILLES RD
FRANKFORT KY
40601-3857
US

V. Phone/Fax

Practice location:
  • Phone: 502-695-3946
  • Fax: 502-695-3847
Mailing address:
  • Phone: 502-695-3946
  • Fax: 502-695-3847

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number30388
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: