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General NPI Number Information
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NPI Number | 1316005044
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Entity Type | Organization
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Legal Business Name | MARK VERONNEAU PLASTICS & ENT, PLLC
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Dates
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Enumeration Date | 12/05/2006
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Last Update Date | 06/23/2015
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Provider Practice Location Address
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Address Line | 5322 KY ROUTE 321
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City | PRESTONSBURG
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State | KY
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Zip | 41653-9114
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Country | US
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Telephone | 606-886-2712
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Fax | 606-886-2712
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Provider Business Mailing Address
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Address Line | PO BOX 513
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City | STAFFORDSVILLE
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State | KY
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Zip | 41256-0513
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Country | US
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Telephone | 606-886-2712
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Fax | 606-886-2713
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Authorized Official
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Title or Position | PHYSICIAN
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Name | MARK JOSEPH VERONNEAU
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Credential | D.O.
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Telephone | 606-886-2712
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 231H00000X
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Taxonomy Name | Audiologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number |
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License Number State |
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