Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 03614 | KY |
NPI | 1003803040 |
---|---|
Provider Name | Dr. Philip David Caron |
First Address | Henderson, KY 42419-1079 |
Second Address | Henderson, KY 42420-2938 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2005 |
Last Update Date | 15/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
PA7956 | (05) | SC |