Healthcare Provider Details

I. General information

NPI: 1780903070
Provider Name (Legal Business Name): DAVID B MAYER D O P S C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2010
Last Update Date: 06/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 S CREEK DR SUITE 112
MONTICELLO KY
42633-9472
US

IV. Provider business mailing address

1 S CREEK DR SUITE 112
MONTICELLO KY
42633-9472
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

VIII. Authorized Official

Name: DAVID B MAYER
Title or Position: PRESIDENT
Credential: D.O.
Phone: 606-348-3341