Healthcare Provider Details

I. General information

NPI: 1003803040
Provider Name (Legal Business Name): PHILIP DAVID CARON DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2005
Last Update Date: 02/15/2021
Certification Date: 02/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

736 N ELM ST
HENDERSON KY
42420-2938
US

IV. Provider business mailing address

PO BOX 1079
HENDERSON KY
42419-1079
US

V. Phone/Fax

Practice location:
  • Phone: 270-827-4000
  • Fax: 270-827-5325
Mailing address:
  • Phone: 270-827-0353
  • Fax: 270-827-4966

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number03614
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: