Provider Demographics
NPI:1245207349
Name:MAYER, DAVID BAILEY (DO)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:BAILEY
Last Name:MAYER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ONE SOUTH CREEK DR
Mailing Address - Street 2:SUITE 112
Mailing Address - City:MONTICELLO
Mailing Address - State:KY
Mailing Address - Zip Code:42633
Mailing Address - Country:US
Mailing Address - Phone:606-348-3341
Mailing Address - Fax:606-348-6579
Practice Address - Street 1:ONE SOUTH CREEK DR
Practice Address - Street 2:SUITE 112
Practice Address - City:MONTICELLO
Practice Address - State:KY
Practice Address - Zip Code:42633
Practice Address - Country:US
Practice Address - Phone:606-348-3341
Practice Address - Fax:606-348-6579
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-07
Last Update Date:2015-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY02397208600000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64023971Medicaid
KY64023971Medicaid
D60638Medicare UPIN