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General NPI Number Information
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NPI Number | 1023276177
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Entity Type | Organization
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Legal Business Name | KENTUCKY MEDICAL REHAB CENTER
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Dates
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Enumeration Date | 05/27/2008
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Last Update Date | 02/09/2011
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Provider Practice Location Address
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Address Line | 305 STONEGATE
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City | NICHOLASVILLE
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State | KY
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Zip | 40356
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Country | US
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Telephone | 859-885-1941
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Fax |
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Provider Business Mailing Address
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Address Line | 208 STONE AVE
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City | LEXINGTON
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State | KY
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Zip | 40508-2644
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Country | US
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Telephone | 859-309-1908
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Fax |
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Authorized Official
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Title or Position | RADIOLOGIST/GENERAL PRACTICE
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Name | DR. DARRYL LEE DOCHTERMAN
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Credential | MD
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Telephone | 859-576-8637
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 15283
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License Number State | KY
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