Provider Demographics
NPI:1114919925
Name:DOMURAT, FRANCIS M (MD)
Entity Type:Individual
Prefix:DR
First Name:FRANCIS
Middle Name:M
Last Name:DOMURAT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:FRANK
Other - Middle Name:M
Other - Last Name:DOMURAT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 1410
Mailing Address - Street 2:
Mailing Address - City:CORBIN
Mailing Address - State:KY
Mailing Address - Zip Code:40702-1410
Mailing Address - Country:US
Mailing Address - Phone:954-235-2325
Mailing Address - Fax:888-471-7728
Practice Address - Street 1:1 TRILLIUM WAY
Practice Address - Street 2:BAPTIST HEALTH CANCER CENTER
Practice Address - City:CORBIN
Practice Address - State:KY
Practice Address - Zip Code:40701-8727
Practice Address - Country:US
Practice Address - Phone:606-523-1934
Practice Address - Fax:606-523-1982
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-17
Last Update Date:2014-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 100326207RX0202X
KY45134207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100195430Medicaid
KYK037680OtherMEDICARE PTAN
KYP01074854OtherRAILROAD MEDICARE PTAN
AKMD4172Medicaid
KY037680Medicare PIN
AKB72280Medicare UPIN
AKMD4172Medicaid