Healthcare Provider Details

I. General information

NPI: 1639139215
Provider Name (Legal Business Name): DARON G DAVIS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2006
Last Update Date: 03/13/2020
Certification Date: 03/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

290 BIG RUN RD
LEXINGTON KY
40503-2903
US

IV. Provider business mailing address

290 BIG RUN RD
LEXINGTON KY
40503-2903
US

V. Phone/Fax

Practice location:
  • Phone: 859-685-0600
  • Fax: 859-260-1003
Mailing address:
  • Phone: 859-685-0600
  • Fax: 859-260-1003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZN0500X
TaxonomyNeuropathology Physician
License Number22701
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number22701
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: