Provider Demographics
NPI:1912018433
Name:BADGER, BRIAN CLIFFORD (MD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:CLIFFORD
Last Name:BADGER
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 1:116 FAIRFIELD DR
Mailing Address - Street 2:
Mailing Address - City:MT STERLING
Mailing Address - State:KY
Mailing Address - Zip Code:40353-9385
Mailing Address - Country:US
Mailing Address - Phone:859-361-4845
Mailing Address - Fax:
Practice Address - Street 1:401 COMMERCE CIR
Practice Address - Street 2:
Practice Address - City:MT STERLING
Practice Address - State:KY
Practice Address - Zip Code:40353-7815
Practice Address - Country:US
Practice Address - Phone:859-498-5243
Practice Address - Fax:859-498-5396
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2014-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY39377208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1223055OtherCHA
KY64106578Medicaid
KY7134692OtherAETNA
KY0000000365234OtherANTHEM
KY611215814OtherBLUEGRASS FAMILY HEALTH