Provider Demographics
NPI:1639139215
Name:DAVIS, DARON G (MD)
Entity Type:Individual
Prefix:DR
First Name:DARON
Middle Name:G
Last Name:DAVIS
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 1:290 BIG RUN RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-2903
Mailing Address - Country:US
Mailing Address - Phone:859-685-0600
Mailing Address - Fax:859-260-1003
Practice Address - Street 1:290 BIG RUN RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-2903
Practice Address - Country:US
Practice Address - Phone:859-685-0600
Practice Address - Fax:859-260-1003
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2020-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY22701207ZN0500X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZN0500XAllopathic & Osteopathic PhysiciansPathologyNeuropathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64227010Medicaid
KY64227010Medicaid
KY0058120Medicare PIN
KY0085115Medicare PIN
KY0084019Medicare PIN