Healthcare Provider Details

I. General information

NPI: 1770510786
Provider Name (Legal Business Name): JAVALI B AROON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2006
Last Update Date: 10/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

627 W FOURTH ST EASTERN STATE HOSPITAL
LEXINGTON KY
40508-1294
US

IV. Provider business mailing address

627 W FOURTH ST EASTERN STATE HOSPITAL
LEXINGTON KY
40508-1294
US

V. Phone/Fax

Practice location:
  • Phone: 859-246-7000
  • Fax: 859-246-7023
Mailing address:
  • Phone: 859-246-7000
  • Fax: 859-246-7023

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number18574
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: