Provider Demographics
NPI:1861445330
Name:PICON, DORA A (MD)
Entity Type:Individual
Prefix:DR
First Name:DORA
Middle Name:A
Last Name:PICON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:789 EASTERN BYP
Mailing Address - Street 2:SUITE 25
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-2415
Mailing Address - Country:US
Mailing Address - Phone:859-623-3560
Mailing Address - Fax:859-623-3763
Practice Address - Street 1:789 EASTERN BYP
Practice Address - Street 2:SUITE 25
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-2415
Practice Address - Country:US
Practice Address - Phone:859-623-3560
Practice Address - Fax:859-623-3763
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2010-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY263782084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64263783Medicaid
KY64263783Medicaid
KY0914001Medicare ID - Type Unspecified