1114919925 NPI number — DR. FRANCIS M DOMURAT M.D.

Table of content: DR. FRANCIS M DOMURAT M.D. (NPI 1114919925)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114919925 NPI number — DR. FRANCIS M DOMURAT M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DOMURAT
Provider First Name:
FRANCIS
Provider Middle Name:
M
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DOMURAT
Provider Other First Name:
FRANK
Provider Other Middle Name:
M
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1114919925
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/31/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1410
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CORBIN
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40702-1410
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-235-2325
Provider Business Mailing Address Fax Number:
888-471-7728

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 TRILLIUM WAY
Provider Second Line Business Practice Location Address:
BAPTIST HEALTH CANCER CENTER
Provider Business Practice Location Address City Name:
CORBIN
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40701-8727
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-523-1934
Provider Business Practice Location Address Fax Number:
606-523-1982
Provider Enumeration Date:
08/17/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RX0202X , with the licence number:  ME 100326 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RX0202X , with the licence number: 45134 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 7100195430 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: K037680 . This is a "MEDICARE PTAN" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: P01074854 . This is a "RAILROAD MEDICARE PTAN" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: MD4172 , issued by the state of ( AK ) . This identifiers is of the category "MEDICAID".




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