Provider Demographics
NPI:1356314199
Name:TOADVINE, STEPHEN K (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:K
Last Name:TOADVINE
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 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:606-546-9363
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:606-546-9363
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY26037207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64260375Medicaid
KYE61178Medicare UPIN
KY64260375Medicaid