Healthcare Provider Details

I. General information

NPI: 1801841572
Provider Name (Legal Business Name): VAN S BREEDING MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 12/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

226 MEDICAL PLAZA LANE
WHITESBURG KY
41858
US

IV. Provider business mailing address

PO BOX 40
WHITESBURG KY
41858
US

V. Phone/Fax

Practice location:
  • Phone: 606-633-4871
  • Fax: 606-633-8798
Mailing address:
  • Phone: 606-633-4871
  • Fax: 606-633-8798

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number26664
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: