Healthcare Provider Details

I. General information

NPI: 1245207349
Provider Name (Legal Business Name): DAVID BAILEY MAYER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2006
Last Update Date: 04/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ONE SOUTH CREEK DR SUITE 112
MONTICELLO KY
42633
US

IV. Provider business mailing address

ONE SOUTH CREEK DR SUITE 112
MONTICELLO KY
42633
US

V. Phone/Fax

Practice location:
  • Phone: 606-348-3341
  • Fax: 606-348-6579
Mailing address:
  • Phone: 606-348-3341
  • Fax: 606-348-6579

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number02397
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number02397
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: