Provider Demographics
NPI:1932208899
Name:VERONNEAU, MARK J (DO)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:J
Last Name:VERONNEAU
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 513
Mailing Address - Street 2:
Mailing Address - City:STAFFORDSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41256-0513
Mailing Address - Country:US
Mailing Address - Phone:606-886-2712
Mailing Address - Fax:606-886-2713
Practice Address - Street 1:5322 KY ROUTE 321
Practice Address - Street 2:SUITE 2
Practice Address - City:PRESTONSBURG
Practice Address - State:KY
Practice Address - Zip Code:41653-9114
Practice Address - Country:US
Practice Address - Phone:606-886-2712
Practice Address - Fax:606-886-2713
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY02996207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology