Healthcare Provider Details

I. General information

NPI: 1912341264
Provider Name (Legal Business Name): PAUL BRADLEY BRASHER JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2013
Last Update Date: 11/27/2023
Certification Date: 06/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 PLEASANT VALLEY RD STE 404
OWENSBORO KY
42303-9774
US

IV. Provider business mailing address

PO BOX 23229
OWENSBORO KY
42304-3229
US

V. Phone/Fax

Practice location:
  • Phone: 270-417-7515
  • Fax: 270-417-7699
Mailing address:
  • Phone: 270-691-8070
  • Fax: 270-691-8026

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number63296
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberTL 39349
License Number StateSC
# 3
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number52453
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: