Organization
R DAVID FANT MD PSC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. R DAVID FANT MD (OWNER)
(270) 651-7736
Entity
Organization
Contact information
Practice address
1407 NORTH RACE ST, GLASGOW, KY 42141
(270) 651-7736
(270) 651-9552
Mailing address
PO BOX 517, GLASGOW, KY 42142-0517
(270) 651-7736
(270) 651-9552
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
64191117
—
KY
Enumeration date
03/05/2008
Last updated
03/05/2008
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