Healthcare Provider Details

I. General information

NPI: 1902868532
Provider Name (Legal Business Name): RUBEN CUADRADO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2006
Last Update Date: 03/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1029 MEDICAL CENTER CIR STE 306
MAYFIELD KY
42066-1189
US

IV. Provider business mailing address

1029 MEDICAL CENTER CIR STE 306
MAYFIELD KY
42066-1189
US

V. Phone/Fax

Practice location:
  • Phone: 270-251-4575
  • Fax: 270-251-4577
Mailing address:
  • Phone: 270-251-4575
  • Fax: 270-251-4577

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number30255
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: