Provider Demographics
NPI:1235280579
Name:BRABON, DAVID LAWRENCE (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:LAWRENCE
Last Name:BRABON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 869
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:KY
Mailing Address - Zip Code:40456-0869
Mailing Address - Country:US
Mailing Address - Phone:606-256-4148
Mailing Address - Fax:
Practice Address - Street 1:140 NEWCOMB AVE
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:KY
Practice Address - Zip Code:40456-2728
Practice Address - Country:US
Practice Address - Phone:606-256-4148
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-15
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY174102086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
88178OtherCHA
000000039562OtherANTHEM BC BS
KY64174105Medicaid
KY17410OtherMEDICAL LICENSE
KY240007115OtherRAIL ROAD MEDICARE
KY1300124OtherDEPT OF LABOR
61-1350713OtherTAX ID
61-1350713OtherTAX ID
KY64174105Medicaid
KYC73989Medicare UPIN