Basic Information
| Provider Information | |||||||||
| NPI: | 1235280579 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BRABON | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | LAWRENCE | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 869 | ||||||||
| Address2: | |||||||||
| City: | MOUNT VERNON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 404560869 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6062564148 | ||||||||
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| Practice Location | |||||||||
| Address1: | 140 NEWCOMB AVE | ||||||||
| Address2: | |||||||||
| City: | MOUNT VERNON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 404562728 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6062564148 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/15/2007 | ||||||||
| LastUpdateDate: | 12/05/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086S0122X | 17410 | KY | Y | Allopathic & Osteopathic Physicians | Surgery | Plastic and Reconstructive Surgery |
ID Information
| ID | Type | State | Issuer | Description | 88178 | 01 | CHA | OTHER | 000000039562 | 01 | ANTHEM BC BS | OTHER | 64174105 | 05 | KY | MEDICAID | AB7114666 | 01 | KY | DEA | OTHER | 17410 | 01 | KY | MEDICAL LICENSE | OTHER | 240007115 | 01 | KY | RAIL ROAD MEDICARE | OTHER | 1300124 | 01 | KY | DEPT OF LABOR | OTHER | 61-1350713 | 01 | TAX ID | OTHER |