Provider Demographics
NPI:1568467686
Name:YORK, DAVID J (PAC)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:J
Last Name:YORK
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2200 E PARRISH AVE
Mailing Address - Street 2:BLDG D SUITE 100
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-1449
Mailing Address - Country:US
Mailing Address - Phone:270-688-1770
Mailing Address - Fax:270-688-1781
Practice Address - Street 1:2200 E PARRISH AVE
Practice Address - Street 2:BLDG D SUITE 100
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-1449
Practice Address - Country:US
Practice Address - Phone:270-688-1770
Practice Address - Fax:270-688-1781
Is Sole Proprietor?:No
Enumeration Date:2005-06-15
Last Update Date:2013-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA834363AS0400X
IN10000605A363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000318604OtherANTHEM BLUE CROSS
000000318604OtherANTHEM BLUE CROSS
P89990Medicare UPIN
KY0649915Medicare PIN
KYP00386250Medicare PIN
IN202280JMedicare PIN