Provider Demographics
NPI:1811933989
Name:CATRON, MARK OTIS (PAC)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:OTIS
Last Name:CATRON
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 PLAZA DR STE 3
Mailing Address - Street 2:
Mailing Address - City:BEREA
Mailing Address - State:KY
Mailing Address - Zip Code:40403-2087
Mailing Address - Country:US
Mailing Address - Phone:859-986-1370
Mailing Address - Fax:
Practice Address - Street 1:133 PLAZA DR STE 3
Practice Address - Street 2:
Practice Address - City:BEREA
Practice Address - State:KY
Practice Address - Zip Code:40403-2087
Practice Address - Country:US
Practice Address - Phone:859-986-1370
Practice Address - Fax:859-986-1374
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2014-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA144363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY95002697Medicaid
KY970026471OtherRAILROAD MEDICARE
KY0650710Medicare PIN
KY970026471OtherRAILROAD MEDICARE
KY95002697Medicaid
KY0576411Medicare PIN