Provider Demographics
NPI:1629122643
Name:PAVON, HECTOR EDUARDO (MD)
Entity Type:Individual
Prefix:
First Name:HECTOR
Middle Name:EDUARDO
Last Name:PAVON
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 1:298 MAIN ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:CADIZ
Mailing Address - State:KY
Mailing Address - Zip Code:42211-9155
Mailing Address - Country:US
Mailing Address - Phone:270-522-6684
Mailing Address - Fax:270-522-6673
Practice Address - Street 1:298 MAIN ST
Practice Address - Street 2:SUITE 2
Practice Address - City:CADIZ
Practice Address - State:KY
Practice Address - Zip Code:42211-9155
Practice Address - Country:US
Practice Address - Phone:270-522-6684
Practice Address - Fax:270-522-6673
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYLL441173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000046941OtherKENTUCKY BLUE CROSS
KY64994411Medicaid
KYD92450Medicare UPIN
KY1169401Medicare PIN