Provider Demographics
NPI:1043572688
Name:TROXELL, CANDICE GOH (DO)
Entity Type:Individual
Prefix:
First Name:CANDICE
Middle Name:GOH
Last Name:TROXELL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:CANDICE
Other - Middle Name:MARIE
Other - Last Name:GOH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 1150
Mailing Address - Street 2:
Mailing Address - City:BARBOURVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40906-5150
Mailing Address - Country:US
Mailing Address - Phone:606-546-9287
Mailing Address - Fax:606-546-0009
Practice Address - Street 1:215 N ALLISON AVE
Practice Address - Street 2:
Practice Address - City:BARBOURVILLE
Practice Address - State:KY
Practice Address - Zip Code:40906-1336
Practice Address - Country:US
Practice Address - Phone:606-546-9287
Practice Address - Fax:606-546-0009
Is Sole Proprietor?:No
Enumeration Date:2012-06-11
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY03859208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100358110Medicaid
KYK161330Medicare PIN