Provider Demographics
NPI:1336160647
Name:VALENCIA, EFREN BURGOS JR (MD)
Entity Type:Individual
Prefix:DR
First Name:EFREN
Middle Name:BURGOS
Last Name:VALENCIA
Suffix:JR
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 1:3503 CUMBERLAND AVE
Mailing Address - Street 2:
Mailing Address - City:MIDDLESBORO
Mailing Address - State:KY
Mailing Address - Zip Code:40965-2611
Mailing Address - Country:US
Mailing Address - Phone:606-248-7920
Mailing Address - Fax:606-248-7947
Practice Address - Street 1:3503 CUMBERLAND AVE
Practice Address - Street 2:
Practice Address - City:MIDDLESBORO
Practice Address - State:KY
Practice Address - Zip Code:40965-2611
Practice Address - Country:US
Practice Address - Phone:606-248-7920
Practice Address - Fax:606-248-7947
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY19269208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64192693Medicaid
KY0659001Medicare ID - Type Unspecified
KY64192693Medicaid