Healthcare Provider Details

I. General information

NPI: 1730217548
Provider Name (Legal Business Name): DANIEL W LARROW M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 09/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIV OF KY PEDIATRICS KENTUCKY CLINIC J445 740 SOUTH LIMESTONE STREET
LEXINGTON KY
40536-0001
US

IV. Provider business mailing address

UNIV OF KY PEDIATRICS KENTUCKY CLINIC J445 740 SOUTH LIMESTONE STREET
LEXINGTON KY
40536-0001
US

V. Phone/Fax

Practice location:
  • Phone: 859-323-2089
  • Fax: 859-257-9853
Mailing address:
  • Phone: 859-323-2089
  • Fax: 859-257-9853

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number46496
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License Number46496
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: